Biyani's Think Tank

Concept based notes

Medical Surgical Nursing -I
(GNM)

Jitendra Kumar
Deptt. of Commerce & Management
Biyani Girls College, Jaipur

2
Published by :

Think Tanks
Biyani Group of Colleges

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Biyani Shikshan Samiti
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First Edition : 2011

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Medical Surgical Nursing –II

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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

Brief history of evolution of modern medicine and surgery and theories of
illness and it causation.

Illness as human experience.

Nursing process and nursing care plan.


Unit Ii Nursing Assessment

Health Assessment

Physical examination

General clinical investigation


Unit III Patho Physiological Mechanism of Disease

Inflammation

Stress adaptation

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Defense against injury.

Nutritional consideration.

Unit IV Altered Immune Response

Review of Normal Immunity. (Review Unit IV of microbiology)

Altered Immune response, Hypersensitivity and allergy

Nursing management of Immune therapy.

Auto immune disease

Graft versus host disease


Unit V Clinical Pharmacology

Terminology

Drugs and laws.

Basic clinical pharmacology

Sources of drugs, action, side effects, doses and drugs

Different pharmacological preparations.

Administration of medicine to patient.

Nursing implication of administration of drugs.


Unit VI Nurse's role in Management of fluid, electrolyte and Acid base balance

Water content of body.

Homeostasis

Review mechanism of controlling fluid and electrolyte movement

Review regulation of fluid and electrolyte.

Fluid and electrolyte imbalance and their therapeutic management.


Unit VIII Management of Patients in Pain

Concept

Assessment

Types, location

Medical Surgical Nursing –II

Nursing management

Analgesic management

Analgesic drugs

Therapeutic approaches to pain.

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Unit VIII operation theatre technique

Operation theatre; cleaning of rooms, tables, trolleys, lights and other
equipments.

Pre-operative holding area.


Theatre Technique

Scrubbing-hand washing

Gowning

Gloving

Positioning of patient for various surgical procedure


Preparation of Theater equipment & supplies

Cleaning

Packing

Sterilization

Needles, sutures-types and their uses.

Role of a nurse in care of patient in the theatre.

Unit IX Management of patient Undergoing Surgery
Assessment of pre-operative patient – Physical, psychosocial physiology aspects

Nursing management of pre-operative patient.

Intra Operative Management

Surgical Team

Nurse's function in Operation Theater.

Anesthesia; classification, anesthetic agents and role of a nurse in anesthe

Post-operative management-immediate and Routine

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Transferring patient from Operation Theatre.

Patient in recovery room

Recovery from anesthesia.

Post – Operative nursing management

Administration of post-operative orders

Post-operative complications; observation, prevention and management

Unit X Nursing Management of patient with impaired respiratory function a
gaseous exchange.

Assessment of respiratory functions.

Management of patient with impaired respiratory functions.

Respiratory intensive care.

Management of patient with disorders of upper respiratory tract.

Management of patients with disorders of the chest and lower respiratory tract.

Unit XI Nursing Management of patients with digestive and gastro-intestinal
disorders.

Assessment of hepatic an biliary function.

Management of hepatic and billary disorders

Assessment of endocrinal function.

Management of endocrinal disorders.


Unit XIII Nursing Management of patients with renal and Urinary Disorders

Assessment of renal urinary functions.

Managements of patients with urinary and renal disorders.

Renal failure and dialysis.

Renal transplant.


Unit XIV Nursing Management of patients with neurological disorders

Assessment of neurological function.

Management of patients with neurological dysfunctions

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Management of patient with neurological disorders.


Unit XV Nursing management of patients with disorders of connective tissue and
collagen disorder

Assessment

Management of patients with disorders of connective tissue and collagen.


Unit XVI Nursing Management of the Elderly

Assessment of elderly

Ageing process

Helping in promoting wellness and self care.

Health problems in elderly

Unit XVII Emergency Management

Medical surgical emergencies

Nurse's role in emergency conditions.

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Unit I

The Nursing Process
Q.1

Define nursing process?

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

Define disease, end it's course?

Ans.

A state of the body in which one or more ports of body foul to work.

Courses disease:
1. Hereditary disorder

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2. Physical end chemical agent.
3. Drugs, cigarette and alcohol excess of heat or cold electricity or reductive
substance, physical injury.
4. Uncontrolled growth resulting in cancer.
5. Living organism – Bacteria, fanges virus, parasites
6. Disorders of immune system
7. Metabolic dirorder – hormonal, malnutrition

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Unit II

Nursing Assessment
Q.1

Define Health assessment?

Ans.

Health assessment 18 a continuous, systematic process in which assess the
physical and psychological need of on in divided.
o Health assessment are divided in two types
1. Health history- collection of subjective information
2. Physical examination – collection of objective information's
o Health history are divided in following information's
1. Socio-economization
2. Family history
3. Past medical history
4. Surgical history
5. Obsterical history
6. Present medical history

Q.2

Define physical examination?

Ans.

It is a thorough inspection or a detailed study of the entire body or some port of
the body to determine the general physical or mental conditions of the body.
Physical or mental conditions of the body.
Methods of physical examination
1. Inspection
2. Palpation
3. Percussion
4. Auscultation
5. Manipulation
6. Testing reflexes

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Visual examination of the body is called inspection.
Palpation: It is the feeling of the body or a port with the hands to note the size
and positions of the organs. In palpation the finger pacts and not the finger tips
are used.
Percussion: It is the examination by tapping with the fingers on the body to
determine the condition of the internal organs by the sounds that are produced.
Auscultation: It the listening to sounds with in the body with the aid of a
stethoscope, foetoscope, or directly with the car placed on the body.
Monipulations: It the moving of a part of the body to note its flexibility.
Limitation of movements is discovered by this method.
Testing of reflexes: The response of the tissue to extend stimuli & tested by
means of percussion hammer, safety pin wisp of cotton hat and cold water.

Q.3

Explain the role of nurse in nursing assessment?

Ans.

Preparation of the environment:
Maintenance of privacy
Lighting
Comfortable bed or examination table.
The room should be warm and without draughts.
Preparation of the equipment
Preparation of the patient.
Physical preparation mental preparation
Provide psychological support, and explain all details to the patient.

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Unit III

Patho Physiological Mechanism of
Disease
Q.1

Define inflammation and explain it's type?

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.

Supportive: The inflammation in which pus is formed.

6. Traumatie: Inflammation caused by on injury.
7. Ulcerative inflammation: The inflammation over which on clear is formed.

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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

Write short note on thrombosis?

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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Monitor the vital sign
Elastic compression stoking
Non steroidal anti inflammatory drugs are present in case of pain
Educate the patient absent personal hygiene.

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Unit V

Clinical Pharmacology
Q.1

Define medicines?

Ans.

Medicines may be defined as a substance used to promote health to prevent
illness to diagnose to alleviate or cure disease.
Administration of medicine is one of the greatest responsible of a nurse. She
should see that all medicines are administrative in such a way as to obtain best
results for this she should have a through knowledge of the drugs that is
administered by her.

Q.2

What are the 5 rights for a safe administration of drug or Essential of a
medication order?

Ans.

The drug order written by the physician has essential ports:
1. None of the patient: To identify the patient correctly and to avoid confusions
when there are more then one patient with the some name.
2. None of the drug: The name of the drugs should be written clearly and
correctly.
3. Dosage of the drug: The dosage of the drug includes the amount, the strength
and the frequency of administration.
4. The method of administration: It is not consumed for a drug to have several
possible routes of administration. Then fore it is important to specify the
route of administration in the drug order.
5. The date: The date will include the drug. The month and the year, some
times the time when the order written is also included.
The signature of the physician: The signature of the physician makes the drug
order a legal request an unsigned order has no validity.

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Q.3

What are the types of preparation of drugs?

Ans.

Medicines are available in the market indifferent types of preparation. The
preparation may determine the method of administration. The following are the
last of pharmaceutical preparations of drugs: 1. Aqueous salvation: One or more drugs dissolved in water.
2. Capsule: Powdered drugs or liquids within gelatin container
3. Elixir: Solution containing of fat sugar and water.
4. Emulsion: Dispersions of fat globules in water.
5. Lotion: Drugs in liquid suspension intended for external use.
6. Ointment: Semisolid preparations of a drug or drug in petroleum (Vaseline)
7. Pill: Single dose units male by mixing the powered drug with a liquid such
as syrup and rolling the mixture into round or oval shape. It is replace today
by tablets and capsules.
8. Solutions: Liquid preparation s containing one or more substance completely
dissolved in
salved.
9. Syrup : An aqueous solutions of sugar often used to disguise imp easement
testing drugs and soothe irritated membrane.
10. Tablet: Single dose units made by compressing powdered drug into small
hard discs. Some are readily broken along a scored line, some are enteric
coated to prevent irritation to gastric mucosa or to prevent the effect of the
gastric secret upon the drug.

Q.9

Explain the classification of drugs?

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.

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Antipyretics: Drugs which reduced fever.
Anti infective: Use to reduce infection by killing the micro organism or
inhibiting their growth.
Antidotes: Substances used to counteract the effect of poison.
Anti-inflammatory: Drugs help to reduce the inflammation.
Anti-Coagulants: Substances decrease clotting of blood by reducing clotting
factor formation.
Anti histamines: These are the agents used to reduce inflammation or prevent
allergies.
Antacids: These red acc the HC production by blocking H2
Anti- convulsants: These are used to treat fits or convulsions.
Antibiotics: Products of living micro organism that have the ability to destroy
or inhibit the growth of other organism.
Anti diarrheal: Drugs used to treat diarrhea either by detoxicating the noxious
substances or by killing the infectious gastro intestinal micro-organisms or
merely the the irritated bowel mucosa & reduce the spasm.
Antiussives: These act on the cough centre present in central nervous system &
inhibit the cough reflex.
Anti asthmatics: This relaxes the smooth muscles of the bronchioles & provide
relie.
Androgens: Hormones secreted by the tests & the adrenal cortex. They are
steroids which can be symhesized to produce the secondary male characteristics
& building up of provide tissue.
Anti purities: A drugs that relives itching.
Anti Phlogiston: A substance that prevent the infection by inhibiting the growth
of microorganism.
Astringent: A drug that causes the contraction of tissues & stop discharge.
Anti fungal: Drugs which prevent the growth of fungi of tissues & stop
discharge.

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Antispasmodics: An agent that relives the spasmodic pains or spasm of the
muscles.
Antiseptics: Prevent nausa & vomiting.
Anti tubercular: Drugs used to treat tuberculosis.
Antirheumatic: Drugs used to treat rheumatism.
Bronchodilators: Drug relax muscles & help in the expansion of lungs.
Coagulants : Drugs help in the slowing of blood by forming clotting factor.
Carminatives: Drugs used the cause intestinal evacuation, they are subdivided
as follow:
Drastic: Have a violent action.
Laxatives: Relive constipation.
Hydrogogues: Produce watery stool.
Purgatives: These are laxatives but more powerful.
Cholagogues: These are durgs which increase the bile secretion.
Cortico-steriods:These are anti-inflammatory drugs use to prevent inflammation.
Caustics:Substances that are destructive to living tissue.
Diuretics: Increase the urine output

Demulcents: Substances that softens, soothe & protects mucus membrane.
Digestion: An agent that promotes diagesion.
Emetics: Drugs producing vomiting.
Ecbolics or oxytocies: Drugs that stimulate uterine contraction.

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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Hypotensive: Any substance capable of reducing blood pressure. It implies a
persistent effect as opposed to the fleeting effect of a depressor.
Hypoglycaemics: Drugs that lowers the bloos sugar level.
Haematinies: An agent which tends to increase the haemoglobin consult. of the
blood.
Hormones: They are the substitutes for body hormones.
Keratolytics: Drugs which softens the horny layer of the skin & helps its
removal.
Mydriatics: Dialate the pupil of the eye.
Myotics: Dilate the pupil of the eye.
Myotics: Contract the pupil of the eye.
Muscle: Relaxants: Agents used for diminution on tension or functional activity
of muscles.
Nasal decongestants: Drugs produce shrinkage of the engorged nasal
………….& relieve the nasal congestion.
Narcotics: A drugs that produces stupor or complete in sensibility.
Scabicides: A class of topical anti infectives used in the treatment of scabies.
Stypies: An agent that check haemorrhage.
Sedative expectorants: Drugs which lesion parosymal couogh & made it more
effective by soothing the inflamed respiratory mucosa.
Stimulant expectorant: Drug used to increase the bronchial secretion by irritating
the bronchial mucosa.
Sulphonamides: Antibacterial drugs & have a chemical resemblance to para
amino benzoic acid (PABA) a substance needed for the metabolism of micro
organism. Normal utilization of PABA is inhibited when sulphonamide are
present.
Sedatives: Lession the body activity.
Stimulants: Increase the functional activity of an organ or system.
Specific: Have a special curative action in certain disease.

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Stomachies or gastric tonics: Drugs which increase appetite & promote
digestion.
Tranquilizers: These are a class of drugs whose principal effect is to calm,
nervous, ansious, excited or disturbed patients without affecting the clarity of
consciousness.
Thyroid: The cleaned, dried & powered thyroid gland administered orally in the
treatment of thyroid deficiency state.
Vesicants: A blistering agent.
Vermifuge: A drug that expels worms or intestinal parasites.
Vasodilators: Drugs or agents that cause constriction of blood vessels with the
effect of raising the blood pressure.
Urinary antiseptics: Any one of the organic or inorganic compounds when
administered in secreted by the kidneys & either stops of inhibits the growth of
bacteria in the urinary tract.

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Unit VI

Altered Immbre Response
Q.1

Define Immunity with classification?

Ans.

Immunity refers to resistance of a hest of pathogens and their toxie products it is
two types.

1. Innate Immunity: It is due to genetic and constitution make up and individual
prior contract with micro organizer their products is not essential. It may be
specific against a particular organism or non specific. Immute immunity may be
further divided in two types.
Non Specific
Specific Immunity
2. Acquired Immunity: Most potential pathogens are clerk by innate immunity
before they establish on overt infection. It these deference's are breached the
acquired immore system 18 called into play. The resistance that on individual
acquitting life time 18 known as acquired immunity.

Q.2

Explain the acquired immunity on large scale?

Ans.

Acquired immunity are divided into types :
1. Active acquired immunity.
2. Passive acquired immunity.

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Active Immunity

Natured

Artificial

Vaccination
Clinical Infection

Subclinical Infection

Live vaccine

Killed

vaccine
Passive Immunity

Natural

Through Placenta

Artificial

Through Brest Milk

Immune Seram

Immune

Cell

(Fig 1 types of Immunity)

Active immunity: Produced activity by hosts immure system as a results of Antigenic
Stimulation
Passive immunity: Received passively by the rost. No. participant of host immune system.

Q.3

Explain artificial active immunity in vaccines form?

Ans.

This is the resistance induced by vaccines which are preparations of live or killed micro
organisms or their products.
1. Bacterial vaccines:

Medical Surgical Nursing –II

[A] Live:

B.C.G. for Tuberculosis

Ty Z/z for typified
[B] Killed: TAB for enteric fever
Cholera
Pertusis

2. Bacteria products

Tetonus foxoid

Dephtheria foxiod

Capsulor polysaccharide of meningo –cocci

Capsulor polysaccharide of haemophilus influence type

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

Neural and non-neural vaccine for rabies

Influenza

Hepatitis A

Hepatitis B

Japanese encephalitis

Q.4

Explain the factors influencing innate immunity?

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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2. Hormonal influences and sex: There & on increases susceptibility to infection
in endocrine disorders such as diabetes mellitus, hypothyroid, and adrenal dys
functions. Pregnant women are more susceptible to microbial infection due to
increased steroid level during pregnancy.
3. Nutritional factors: Both antibody mediated one cell mediated immunity are
lowered in malnatrion.

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Unit VII

Nurses role in Management fluid
electrolyte and acid base balance
Q.1

Define homeostasis, and explain distribution of body fluids.

Ans.

The balance between fluid and electrolyte in body that term is called
homeostasis.

The body fluid are divided in two types
1. Intra cellular
2. Extra cellular
Intra Cellular are also called cellular fluid it means the fluid are present in body
cells. The total amount pre 70%.
Extracellular fluid are present out of body cell. It is divided in two types.
Intravascular – Plasma and constitute
Intrasitial fluid: Present in cell & space.

Q.2

Define fluid and electrolyte imbalance and their therapeutic management in
details.

Ans.

1. Fluid imbalance: Intake 18 increase and output 18 decrease or intake 18
decrease orel out put increase than condition are called fluid imbalance. Due to
fluid imbalance there are two problems create.
1. De-Hydration
2. Over – hydration
Dehydration: The fluid intake in adequate than condition are dehydration.

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Causes: 1. Profuse sweating in fever.
Water evaporation from the body.
Excessive use of directions.

Sign and symptoms:

Dry skin

Weight loss

Coated tongue

Aligourea

Dark coloured urine

Hypotension

Increased thirst

Sunken eye boll

Diarrhoea

Electrolyte imbalance :
Sodium
Hyponatremia: Leck of sodium in body.
The sign and symptoms of Hyponatremia are:

Abdominal cramps

Convalsion

Tachy cardia

Coll and calmy skin

Hypermatremia : Interested amount of sodium in body.
The clinical features are:
Dry mucous membrane
Flushed skin
Increased thrist
Dry and tough tengue
Monia

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Fever
Potassium

Hypokalemia: Malaise, flabby, muscles, weak pulse hypotension, distention of
abdomen.
Hyperkalemia : collie oligocerea, irregular pulse.
3. Calcium (Ca+2) :Hypocalcemia : Tetony, abdominal distention, conversion, corpopedal spasm.
Hyper calemia: This condition are occur due to excessive secretion of para
thyroid glands hormone.

Therapeutic management of fluid and electrolyte imbalance:

Assessment:

Take the patient history

Monitor the vital sign

Take the client weight daily

Monitor the intake and output chart

Evaluate the energy and bevariour changes

Review the laboratory test

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.

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Nursing implementation:

Manage the fluid and electrolyte intake.

Administer the IV fluid.

[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.

(B) Regulation of flow note:

By manual with clomp

By infusion pump

By volume control

(C) Monitor for complications

Pharmacologic management

Diuretics

Electrolyte replacement

Provide general care – skin care, bed bath sponging mouth wash, hair core
Provide psychological support.

Evaluation : Maintain fluid balance
Serum electrolyte levels are within normal limits
Vital sign are with in normal limits.

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Unit VIII

Management of patient in pain
Q.1

Define pain with pain ratiny scale?

Ans.

Pain is warming signal that 18 related to tissue damage:
According to international association for the study of pain (IASP) "An
unpleasant sensory and emotional experience associated with actual or potential
tissue damage".
Pain is a personal or private sensation of any injury.
Intensity: Pain rating scales are measure the pain intensity.

0

1

2

No Pain

3

4

5

6

7

distressing pain

8

9

10
un-bearable pain

Location

Right

Left

Front

Left

Right

Posterior

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Pattern of pain may be
Constant
Steady
Intermittent

Q.2

Explain the nursing management of pain?

Ans.

The primary nursing diagnosis &

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.

Goal: Assist the patient in ADL (Activities of daily living)
Provide proper rest and comfort.
Provide psychological support.
Provide cool and calm environment.
Analgesics Drugs:
1. Non opioid drugs
Aspirin
Salicylate

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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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Unit IX

Operation Theatre Technique
Q.1

Define O.T. Technique?

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.

Medical Surgical Nursing –II

Q.2

35

What are the use O.T.?

Ans.
S.No.

Position

Name of site of operation

1

Supine or dorsal re

Eye, nose

2

Tendelberg

Intra pelvic surgery

3

Lelral

Operation of kidney such as PCNC, letral part of chest
and hip surgery.

4

Lethiotomy

Operation of external genitalia vagina and perineum
surgery

5

Neck position

Operation

of

neck

specially

trachiostomy,

thyroidectomy
6

Prone

Cerebral operation, surgery of spinal reritibra

7

Sitting

Special in the cranial surgery

8

Knee elbow

It is use for lumber vertibra and it is also use for
removal of prolops of intra vertebral disk.

9

Jack knee

It is use for roctal surgery.

Staff of operation theater:
1. Senior Manager:
Maintain the high standard of the patient care.
Planning and odering.
Welfare of the professional development.
Work as a liason between the surgery anasthatist, laundry department, pharmacy,
department.
2. Theater sister:
Daily management of theater.
Order stock
Liason between surgeon and arasthalist
Observation of immediate sign and symptom before/after the surgery.

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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37

Cover the patient with clear sheet.
Entry should bedone is operation reg.
4. Circular nurse:
A circular nurse is a person who helps the scrub nurse and is available through
out the operation.
(A) Before operation
Ensure that the theater has been clear.
Conform that the light suction and all equipment are is working
condition.
Ensure that the temp. also humidity is control.
Prepare the sterile gloves and gown.
Open the instrument bag, bowl pack and other equipment for the
scrub nurse.
(B) During operation:
Available at all time during the operation.
Count and dispose of spung.
Ensure thest all the door and window, are dosed.
Prepare the dressing tray for the wound dressing.
(C) After operation:
Helps is removal of design.
She should also help in shifting the patient.
Ensure that the patient is sattle and the vital perameter are with is the
normal range.
It there are any deviation is vital perameter shift the patient is
PACU.
Remove the instruments from the myotrauly, count this and send for
auto calve.
Afton washing the scissors they should be kept is formaling
chamber.

38

Ensure that the theater is clear.
The fumigation should be done from the two to three days.

Preparation of operation site:
1. Skill operation
Complete skill, for head neck and ear.
2. Face surgery: Sharing of face, neck ears
3. Is the eye operation the eye brow should be share.
4. Chest operation:
(a) Supine part : Wid abdomes to sholder neck and thorax
(b) Letral part: wid abdomes to sholder is charding the helral aspect of thora.
5. Abdomen's surgery: From nipple to upper part of thigs, extending the round wall
and pelvis including the genital.
6. Genital Surgery: From umbilicus to hid thing and extending the letral round of
pelvis including the genital and anal region
7. Anal region surgery: Appear part of the thing buttocks and oral risk.
8. Spinal surgery: From shoulder to the upper part of things including buttocks.

Medical Surgical Nursing –II

39

Unit X

Management of patient under going
surgery
Q.1 Define anesthesia with classification?
Ans.

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

Explain the role of nursing in Anesthesia?

Ans.

Role of nurse anesthesia:
1. Identification of Patient: It is important state find out the patient its
diagnosis and registration no. assume that the patient is NBM.
2. Evaluation of record:
Check the operation notes.
Check the complete physical examination that has been done.
Check the diagnostic study and all investigation.
Ask the patient about any allergy from the drug.

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41

3. Maintain the adequate environment of operation theater:
By checking the temperature and humidity of OT.
By removing the amounts of the patient.
By send out the unnecessary staff from the OT.
4. Psychological support:
Explain the procedure, its duration and complication anesthesia aften
surgery.
Dean the all droughts by explain the patient for reduce the anxiety.
A meting should be done of patient related to some surgery.
5. Wear the OT drugs: Give the gown to the point before entering is to OT.
6. Adequate positioning should be given to the patient and special precaution
should be given about the spinal anesthesia to the patient that the light
movement may cause neurological problems to the patients.
7. Prepared the emergency equipment: Suction apprates, life saning drug
cardiac monition, O2 selerder, defibrillator, ambu bag ventilator.
8. Observe the any abnormal sign to the patient check the colour of skin

42

Unit XI

Management of patient undergoing
surgery
Q.1

Explain the ICU nursing?

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

Equipment or articles use enthe ICU:
1. Multi functional iron bed with railing system:

Medical Surgical Nursing –II

43

2. Ventilator with multioptinal humidifier.
3. Suckion mechene, compressure and O2 slender supply of O2 in not available.
4. Cardiac monitor with ECG, NIBP [Non inrasive BP] IBP, capnea alarm,
temp recording should be present.
5. Defibrillator machine.
6. Incubation kit.
Laryngoscope
Endo tracheal tube
Stylate or guide wire
Ambu Bag. And
Vegalis forcep.
7. CPR-Troly [Cardiac pulmonary resistance]
8. Central monitoring system.
9. Pulse oximeter (SPO2 Monitor)
10. ECG machine
11. Portable X-ray machine
12. Arterial blood analysis (ABG)
13. Infusion Pump with syinge
14. Refrigerator
15. Vapour Box; (Formaldihyde)
16. Gluco meter
17. Water bed or ultra sonic bed
18. External cardiac pace makes kit
19. Tracheotomy tray.

For long time incubation and present the laryngeal oedeema.
20. Warmerdevice
21. Hot water bottle and heater
22. Torch
23. Percussion hamour

44

24. Tangue depressua
25. Various type tray
Cat down tray it not use none a days. It not use none a days. It is
replace is to long line or central line.
Bone mersow tray
Lumber puncture tray
Aspiration tray
Dressing tray
Bibulizer
26. View box
27. O2 flow meter
28. Vasal cathator
29. Over head ache.
30. Others
Cathator
Ng. tube
ET
Syring
Gown, gloves, cap, mask
Central line
Lives
31. Emergency Drugs
Nitro glycerine
Oopamine
Oobutamine
Adrenater
Atropin
Corticosteroid
Avil

Medical Surgical Nursing –II

45

Dexona
Lexis
Sodaby carb.
Calcium send
Phenargin forthwin
Xylocan
Diazapin
Nicardia

Q.2

Define principles use in ICU?

Ans.

Principles use in the ICU:

1. Close observation of vital pera meter.
2. Prevention from recurrence of disease.
3. Main tain the naemodymanics of the patient.
4. Restore the life of the patient in life threatening situation.
5. Prevent from complication is the bed ridden patient by providing the good
nursing care.
6. Daily bidding spun zing and MBBS care I mouth Bow, bladdes and skin care.
7. Maintain the potency of invasive monitory line.
8. Check the ventilatory adjustment [Tidal vol- 10 ml/kg of body and rate]
9. Maintain support chart.
10. Maintain support of central venous pressure [CVP] 12-16 MM H2O
11. Mention aureate flow of Ionotropic support.
12. Follow the fire rights of administration of drug.
13. Maintain the emergency medicine kit by checking the expirary dater intact level
and any breakage.
14. Maintain the proper treatment and schedule of all records when handling and
taking over the next staff in the awritten about any procedure, perameters,
inversgation, admission and discharge etc.

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.

Role of nurse in ICU Nursing:

Maintain the patient airway:
Assessment of patient by observing the airway.
Check the level of cyanosis
Check the tangue fall.
Check and present the aspiration
Check the pharyngeal airway.
Remove the obstruction by NaHCO3
Give the adequate positioning to the patient.
Check the humidification level.
Check the brathing level.

2. By maintaining the berating petering:
Maintain the adequate environment for breathing pattern.
Check the spo2 level
Remove any obstruction in the air way
Chest physio therapy may be given adequate position to the patient.
The central supply of O2 should be start it the saturation is low.
3. Maintain the circulation:
The circulation can be maintain by checking the vital perameter.
Maintain the hydration of the patient.
Check the IV canulla for any complication such as thrombus.

Medical Surgical Nursing –II

47

Measure the crp.
Check the urinary output in emergency take the patient on ionatrople support.
Maintain the adequate pose toning.
Diuretics should be given in the patient of retention of the fluid.
Sodium restricted diet should be given.
4. Cardiac function:
ECG monitory
Health education about diet and exercise.
Nitro glycerin.
Dopamine and doubtamine
Sedatives

5. Maintain the body temp
6. Other:
Maintain the adequate record of Patient and articles of ICC such as
lives planket etc.
Check the monitory of ventrilator.
7. Check the skin integrity and provide the good nursing care for the bed ridder
patient.
8. Follow up of health teal should be given to patient and relation R/T disease
and and nursing care given he the home.

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.

Medical Surgical Nursing –II

49

Unit XII

Nursing management of patient with
impaired respiratory function and
gaseous exchange
Q.1

Define COPD Write down the aetiology, SIS and management?

Ans.

Chronic obstructive pulmonary disease is also known as chronic obstructive
long disease.
COPD is the group of various disorders, known as asthma, bronchitis, and
emphysema.
Incidence: It is more common in old age and makes are more affected than
female.
Risk factors: Smoking is the major risk factor for COPD.
Asthma: Asthma is a disease of branchial airway which is characterized by
narrowing of airway due to respect and reversible bronehio spasm occur.

Asthma is characterized by three basic events :
Branchiopasm
Excessive mucus secretion
Oedema
Branchitis: Inflammation of the branchi is known bronchitis in which excessive
mucus is secreted which causes cough.
Emphysema: Emphysema is a disorder in which alveolar walls are destroyed and
permanent over distention of alveoli and long tissues, occur due to accumulation of
air in it.
Aetialogy:
1. Cigarette smoking, infeetions air pollution

50

2. Inhalation of physical and chemical irritants
3. Environment factors – Temperature, air, homiletic
4. Stress & emotional upset.
5. Medications – Aspirin and NSAID, B-Blockers

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

Medical Surgical Nursing –II

Antibiotics should be given
Directors can be given.
Anti inflammatory drugs should be use.
Surgical Management
Ballectomy : Bullvectomy is the procedure in which areas with the air are
remove by thoracotomy.
LURS: Long volume reduction surgery.
Nursing Management:
Nursing diagnosis
Ineffective airway R/T obstruction in bronchial tree.
Goal : Patient will have effective airway.
Interventions:
Proper position
Suctioning
Tracheostomy core
2. Impaired breathing pattern R/T disease process
Goal: Patient should have sufficient breathing pattern.
Intervention:
Administer oxygen by using bag and mask.
Administer branch dilators.
3. Altered nutrition less then body requirement R/T reduce appetite.

Goal: patient should have normal body weight.
Intervention:
Advise the patient to have small frequent feed
Advise the patient to avoid gas producing food
Give intravenous vitamins
4. Anxiety R/T disease process
Goal: Patient have reduce anxiety.

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.

6. Knowledge deficit R/T disease process
Goal : Provide Health Education
Intervention:
Maintain personal hygiene
Maintain skin integrity
Provide knowledge about disease, causes, sign, symptoms and
treatment

Q.2

Define pneumonia, write down causes, signs and symptoms and
management?

Ans.

Inflammation with consolidation of long tissues is known as pneumonia:

Etiology:
Bacterial – pneumococcus, streptococcus.
Chicken poxvirus
Fungal pneurmonia – cry ptococcosis
Aspiration of fluids
Risk factor:
Malnutrition
Immuno suppression

Medical Surgical Nursing –II

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

2. Breathing in sufficiency : - Proper position, oxygen administration by using
mask and bag.
3. Prevention of from infection.
4. Skin care – to prevent badores
5. Reducing the anxiety by using psycho-emotional
6. Provide health education R/T personal hygiene.

Q.3

Define long abscess? Write the management of such case?

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.

Multiple long abscess

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

Medical Surgical Nursing –II

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

Nursing management of patients with
digestive and
Gastro intestinal disorders
Q.1

Define peptic wear. Write down dictary and nursing management?

Ans.

Peptic weer disease involve the discontinuity of muces: membrane in the
oesophages, gastric, and duodenal part basically it is caused by excessive
secretion of HCI and pepsi.
Etilogy:
1. Increase or chronic intake of aspirin, NSAI and anti inflammatory drugs,
alcohol may damage the mucas memsrone.
2. Zollinger – Elision syndrome : The abnormal secretion hormone gastrin is
known as zollinger- elision syndrome
3. Stess: pepticuleer is psycho-somatic disorder
4. Spicy foods

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.

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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

Write down sign and symptoms etiology and management of gastritis?

Ans.

It is on inflammation of the gastric maeosa. It is two types
1.

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

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59

H+ inhibitors – ranitidine
4. In case of non steroidal anti inflammatory drug (NSAID) ingestion of PGE
(Prostaglandin

E) should be given.

5. Symptomatic drug may also be give
Domperidon
Metrogyl
6. Provide health education relation to personal hygiene

Q.3

Define intestinal obstruction, it's sign and symptom and nursing
management

Ans.

Intestinal obstruction is a condition in which forward flow of intestine contents
is impair partially or completely.
Incidence: 90% of intestinal obstruction occurs in small intest. Intestinal
obstruction is a surgical emergency and show be treated with in 24 hrs.
otherwise it may lead death also.

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

What is jaundice? Describe the signs/symptoms, treatment and nursing
management?

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 %

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61

Direct bilirusin leval or conjugated = 0.1 – 0.3 mg %
Indirect bilirasin level or unconjugated = 0.2 – 0.8 mg %

Un conjugated hyperbilirubinemia : It occurs out side the liver. In which
unconjugated bilirabin level decrease in the blood due to haemotysis.
Conjugated: Conjugated hyperbilirusin may result from impaired expression of
bilirasin from the liver due to hepato celluler disease.
Obstructive Jaindice: It is also known as biliary obstruction it occurs due to gali
stone in the extra hepatie dvet.

Sign and symptoms:
1. Yellow sclera and nucas membrane and skin
2. Yellow colored urine
3. Fatigue
4. Anorexia
5. Abdominal pain
6. Nausea and vomiting
7. Weight loss
8. Headache, fever, chills in case of infection

Clinical diagnosis

1. Liver diagnosis
2. Blood investigation
3. Electrolyte estimation

Management:
1. Removal of fluid by using intestinal tube.

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2. Decompression – decompression is a procedure in which the abdominal contents
are decompressed by using CO2 or other gasic the see 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. 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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Provide the drugs according doctors order
Maintain the intake and out put chart.
Provide the psychological support to the patient.
Patient feel anxiety than provide the antianxietie durgs.
Prepare the patient for surgical procedure.
Provide health education about personal hygiene, rest, diet active and passive
exercise and medication etc.

Q.5

Define hepatitis with management?

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

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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

What is cirrhosis liver? Explain the management in details?

Ans.

Cirrhosis of the liver is characterized by scarring. It is a chronic disease. Due to
inflammation the fibrosis and nodules are character bed.
Most common cirrhosis due to chronic alcoholism and malnutrition.

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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Assess level of consciousness
Provide psychological support to the patient.
Provide the knowledge about the disease process.

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Unit XIV

Nursing management of patients with
metabolic and endocrine disorder
Q.1

What do you under stand by diabetes mellitus? And explain the nursing
management in details?

Ans.

Diasetes mellitus is a metabolic disorder characterized by hyperglycemia and
results from

defective insulin production secretion or utilization.

Path physiology/Etilogy
1. Absolute or relative lack of insulin produced by the beta cell resulting in hyper
glycemia

There are two types of diabetes mellitus
a. NIDDM: Impaired secretary response of insulin to rises in glucose
b. IDDM: Viral autoimmune and environment

Heredity/genetics and abesity play a major role.

Clinical manifestation:
[A] Hyperglycemia

Weight loss, fatigue

Polyuria, poly dipsia, poly phagia

Blurred vision

[B] Altered tissue response
– Poor wound healing
Recurrent infections, particularly of the skin.

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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.

Weight reduction is the primary treatment of diabetes mellitus.

Exercise: Regularly scheduled exercise to promote the utilization of carbohydrates, assets with
weight control enhance the action of insulin, and improve cardio vascular fitness.

Medication: Oral hypoglycemic agent insulin therapy.

Preventing injury secondary to hypoglycemia

Improve activity tolerance

Maintain skin integrity

Improve coping strategies

Provide knowledge to the patient about survival skills, lifestyle management
skills.

Q.2

Write short notes on hyperthyroidism?

Ans.

This hyper metabolic condition is characterized by excursive amounts of thyroid
hormone in the blood stream

Etiology:
1. Over functioning of entire gland
2. Toxic malfinodular goiter
3. Emotional upset

Medical Surgical Nursing –II

4. Worry, over work anxiety
5. Acute infection

Sign and symptoms
1. Nervousness, emotional liability, irritability
2. Difficulty in sitting quietly
3. Rapid pulse rate as well as on exertion, palpitations
4. Profuse perspiration
5. Increases appetite and progressive weight loss
6. Weakness omenorrhoea
7. Bulging eyes
8. Phyroid gland may be pulpable and a bruit may be abscultated over gland
9. Delirium, disorientation
10. Fever, dehydration, hypertension, dysonoea

Management
1. Antithyroid medicines – methamazole
2. Radio – Iodine therapy – for middle age.
3.

(beta) adrenergic blockers

Subtotal thyroideetomy or total thyroideetomy

Monitor the cardiac rate and rhythm continuous.

Maintain the adequate cardiovascular function

Maintain the fluid and electrolyte balance

Maintain supportive nursing care, (personal hygiene)

Provide comfort

Provide psychological support

Provide knowledge about disease causes complications and treatment

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70

Q.3

Write short notes on diabetic ketoacidosis?

Ans

Diabetic ketoacidosis (DKA) is an acute amplication of diabetes mellitus
characterized by hyperglycemia, ketonuria, acidosis, and dehydration
Clinical Manifestation
Early :
Polydipsia, polyuria
Fatigive, malaise, drowsiness
Anorexia, nausea, vomiting
Abdoninal pain, muscles cromps
Later:
Deep respiration (Kussmanl respiration)
Fraity sweet breath
Hypotension and weak pulse
Stupor and coma

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

Nursing Management of Patients with
Rural and Unary Disorder
Q.1

What is acute renal failure? Describe is etiology, sign and symptoms treatment
and nursing management?

Ans.

Acute renal failure is a syndrome of verging causation that results in a sudden
decline in renal function.

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 :

The precipitating factors are :
1. Increased soluble concentration of calcium oxalate, cystein, phosphate, peurin.
2. Reduced amount of inhibitions.
3. Alfered PH of urine.
4. Prolong stonding, dehydration, reduced fluid intake.
5. Excessive exercise
6. Increase close of vitamin C
7. Some medications also cause stone – folic acid and calcium carbo
8. Inflammatory bowal disease
9. Hereditary – xonthire store

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

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Q.3

Write short notes on bacterial pyalonephrits?

Ans.

Inflammation of renal pelvis and renal porencyma that is called pyelenephrits.

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Causes: Bacteria: E – Cali, coronary distraction infectin trauma, pregnancy, metasalic
disorders, diabetes mellite

Clinical Feature: Fever with chills, flank, pain, tenderness, nausea, vomiting, headeale,
muscular, pain

Diagnosis: Urine test.

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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3. Treatment of associated conditions to improve renal dynamics
 Amemia
 Acidosis
 Hyperkalemia
 Phosphate Retention
 Complication
Death
Nursing Management
 Maintaining fluid and electrolyte balance
 Maintaining adequate nutritional status.
 Maintaining skin integrity
 Administer drugs for relief of itching of indicated
 Encourage high fiber diet, braining in mind the potassium content of some frank
and vegetables.
 Increase activity as federated
 Administer medications as ordered :
Phosphate binding medication such as aluminum hydroxid or calcium
carbonate
Calcium supplements between meals to increase serum calci
Vitamin D increase desorption and utilization to calcium
Prepare patient for dialysis or kidney transplantation
Discuss option of supporting psychotherapy for depression
Provide for sefl care
Promote decision making by the patient
Refer patient and family members to renal support agencies
Provide knowledge regarding weight self every morning to avoid fluid
over load
Drink limited amounts aonly when thirsty
Eat food before drinking fluids to alleviate dry mouth.

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Unit XVI

Nursing Management of Patients with
Neurological Disorders
Q.1

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.

Types of brain injuries include concession, cerebral contusion brain stem
contusion, epidural hematomo, and skill fructure.
Caused by blant or penetrating injury.

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

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Management :
Management of increased ICP
Antibiotics to prevent infection

Surgery for evacuation of intro cranial hematoma
Complication
1. Infection
2. Increased ICP
3. Service disorder
Nursing management
1. Maintain adequate cerebral perfusion
Maintain a patient Airway
Monitor ICP
Administer IV solutions slowly to avoid over dehydration and edg.
2. Maintaining respiration
Monitor respiratory rate, depth, and pattern of respiration
Assist with intubation of needed
Suctino patient as needed.
3. Meeting nutritional status (needs)
Provide nasogastric feedings
Administer IV hyper alimentation as ordered
4. Promoting cognitive function
Provide stimulation of all sensory avenues
Involve family in sensory stimulation program
Provide frequent concern orientation information
5. Preventing injury
Instruct the family regarding the behavioural phases of recovery from
brain injury. Such as restlessness and combative
Provide passive mation exercise

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6. Strengthening family coping
Provide psychological support help the family assist the patient to
recognize current progress
Educate the family members about disease progress

Q.2

Define meningitis and it's management?

Ans.

Meningitis is the inflammation of the meanings or membrane living the brain
and spinal cord.
Usually secondary to other bacterial infection such as sinusitis, eitis media,
pnecmenia, endocarditis.
Common bacterial organism neisseria meningitis (meninge coccal
meningits)

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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Daken the room if photophobia is present
5. Patient education
Encourage the patient to follow medication
Encourage follow up and prompt attention to infection in facture.

Q.3

Define encephalitis, it's clinical manifestation and treatment?

Ans.

Encephalitis is the inflammation of cerelrit tissue caused by on infection agent
or other toxin.
A virusa, including rasio virus, the enter virus and the harpes virus are common
inteetious agent.
Clinical manifestation: Fever, headache, meaning sign nasusea and vomiting,
confusion, seizure etc.
Diagnostic evaluation : CSF. CT Scan, MRI, EEG

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

Define seizures and explain treatment in detailed?

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

Define Parkinson's disease and explain its mono.

Ans.

Parkinson's disease is a progressive neurologic disease affecting the brain
contents responsible for the control and regulation of movement.

Risk factor : Altherosderosis of muscles; Arterial hyper tension, diabetes hyper
lipidemia

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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Improve mobility and functioning of patient.
Encourage the patient for self core.
Maintain input and out put charting.
Prevent from any type of complication and injury
Provide adequate nutrition diet.
Provide health education regarding disease causes about procedure during core,
treatment of disease.

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Unit XVII

Nursing Management of Patient with
Disorders of
Connective Tissue and Collagen disorder
Q.1

Define rheumatoid arthritis and it's clinical manifestation?

Ans.

Rheumatoid arthritis is a general term used to describe what may be a
heterogeneous of inflammatory disease affecting both joints and other organ
systems.

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

Explain the management of rheumatoid authritis?

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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4. In effective individual coping related to pain physical limitations.

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

Define gout and patient classification?

Ans.

Government is a disorder of purine metabolism characterized by elevated uvic
acid and deposition of urate in joints and other tissues.

Pathophysialogy

Government results from on overasumdent accumatation and subsequent deposition
of uric acid in the body this can occur in one of two ways.

1. Over production of uric acid (10% of cases)
2. Certain disease conditions
3. Lymphopraliferative disorders
4. Cancer chemotherapy
5. Hemolytic onemias
6. Psoriasis

2. Under excretion of uric acid (90% of cases)

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Renal disease endocrime disorder medications

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

Explain the management of government in detail?

Ans:

(A) Pharmacologic
NSAIDS for acute attacks to relieve pain and swelling
Corticosterocls: Intra articulor if attack combined to one joint.

(B) Urate – lowing agents:
Uricosuric drugs such as probe acid (benamid) inter fere with tubular
reasorption of uric acid.
Allopurine – interferes with conversion of hypes xonthine and xonthine to uric acid.

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(D) Non pharmacologic
Avoidance of obesity
Aviodenceof alcohol
Low purine diet gives only a minor decrease in serum aric acid level.

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

Define psoriatic arthritis with clinical manifestations?

Ans.

Psoriatic arthritis is on inflammatory arthritis that can be seen in patient with
psoriatic skin disease or psoriatic nail disease.

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Pathphysiology: Disease manifestation is probably on interaction among
immane, genetic, and emission mental factor.

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

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Unit XVIII

Nursing management of the Elderly
Q.1

Define Gerontological nursing or aging process ?

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

What are the common health problems in older adults?

Ans:

Common health problems are:

1. Cardio vascular disease – hypertension ischemic heart disease, heat failure,
dehydration, storke.
2. Neurologic: Parkinsonism, alzeimer's disease or dementia depression, psychosis,
sleep disturbance, subdural hematoma
3. Respiratory: COPD, dysnnea, pneumonia
4. GIT: Constitution dearrhoea hernia, dysphagia anorexia
5. Genitourinary: Renal insufficiency urinary maintenance UTI, enlarged prostate,
sexual syfunetion
6. Endocrine: Din, Gout, hyper or hypothyroidism
7. Musculoskeltal : Osteopoross osteomalacia, osteotrthritis fractures.
8. Arthritis may proceed the development of skin disease.

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9. Nail disease present in the large majority of patients with psoniatic arthritis

Extra articular- manifestations
1. Eye inflammation – conanetivitis
2. Pulmonory filonsis
3. Aortic insufficiency

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

Define basic approach to emergency core?

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

Explain the emergency assessment with triage categories?

Ans.

A systematic approach to the assessment of on emergency patient is essential
often. The most dramatic injury is not the most serious. The primary and
secondary survey provide the emergency nurse with a methodical approach he
help identity and prioritize patient needs.

Airway does the patient have on open airway?
Breathing is the patient breathing?
Circulation – circulation in immediate jeopardy?
[A] Is there a puse?
[B] Is there profuse bleeding?

Disability assess level of consciousness and pupils
Assess level of consciousness using the AVPU scale.
1. A – Istle patient alert
2. V – Does the patient respond to voice?
3. P – Does the patient respond to painful stimules?
4. U – The patient is corresponsive even to painful stimules

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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

Explain the management of ageing process?

Ans.

Promoting self core and wellness in elderly
Assessment : - Assess the cardiovascular staths
Monitor the vital signs
Observe for any complications
Edema
Dyspnea
Chost pain
Assess the visual and auditory activates.
Assess the sign of cancer.

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

Encourage the regular medical, dental, and visual examination
Assess the living conditions to prevent for any injury
Refer self help group
Develop the new interest

Medical Surgical Nursing –II

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Assess the nutritional status
Encourage for light exercise
Educate the patient for elderly process and complication in elderly.
Encourage for personal hygiene.

Q.3

Explain the sign and symptoms with treatment end nursing core?

Ans.

Sign and symptoms
Hot and dry flushed skin
Pallor skin
Body temperature more than 7,105 of
Complaints of dizziness, nausea, and headaches
Convulsing
Altered level of consciousness

Treatment and nursing core
Maintain the temperature by hypo thermia blancket cold water baths,
coolenemus
Administer O2 to meet increase metabolic demands
Institute seizures precautions
Hypothermia
Sing and symptoms
Local : pallor, paresthesia, absence and sensation to involved body port
Systemic : Body temperature < 94% wealc and irregular pulse, decreased level of
consciousness

Treatment and nursing core:
Monitor the patient condition for any complications
Assess the cardiac status

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Maintain the electrolyte balance
Arterial blood gases
Blood, urea, nitrogen
Use, warmer
Correct fluid and electrolyte imbalance etc.

Priorities of core/Triage categories
Eonergent I: conflations requiring immediate medical intonation any delay in treatment
is potentially life or lions threatening
Includes conflations are
Airway compromise
Cardiac arrest
Severe shock
Cervical spinal injury
Multisystem trauma
Altered level of consciousness
Eclompsia

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 :

Medical Surgical Nursing –II

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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.

Condition are : Chronic low back pain
Dental problems
Missed menses
Roatine medication refillis.

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