Test or Examination for Virginity

Evidence-Based Guiding Note

What exactly is virginity testing?

The inspection of the female genitalia to determine if the examinee has had or has become accustomed to sexual intercourse is known as ‘virginity testing.’ Some tribes conduct ‘virginity testing’ to determine which women or girls are ‘virgins’ (i.e. have not had sexual intercourse). As part of the sexual assault examination of female rape survivors, some medical practitioners perform ‘virginity testing.’

The two most popular ‘virginity testing’ procedures are visual inspection of the hymen for size or rips and two-finger vaginal insertion. The goal of the latter is to assess the size of the introitus or the laxity of the vaginal wall, as well as the existence of the hymen, which is a thin membrane in the vaginal entrance that some cultures believe remains intact until women have sexual intercourse. However, research suggests that this form of testing may not give reliable findings since the existence and characteristics of the hymen vary from woman to woman and the membrane can rupture or stretch during daily activities other than sexual intercourse.

 

What are the consequences of ‘Virginity Testing’?

‘Virginity testing’ causes physical, physiological and social harm.

Physical harm: In the case of survivors of abuse, ‘virginity exams’ may cause physical injury to the women and girls being evaluated, including worsening existing injuries. Harm may also come from family who, as a result of a perceived ‘failed’ test, may harm or murder the lady or girl in the sake of ‘honour.’ As a result of the ‘virginity testing,’ some women or girls have self-harmed or tried suicide.

Psychological harm: Women and girls who have had ‘virginity tests’ have reported tremendous dread and anxiety before the test, as well as shouting, weeping, and fainting during the exam. Women and girls have also experienced long-term repercussions such as self-hatred, loss of self-esteem, depression, a sense of invasion of privacy, and re-victimization (for survivors of sexual assault).

Social harm: ‘Virginity testing’ is frequently connected with damaging traditional and cultural traditions that subject women and girls to stigma, humiliation, and dishonour in front of their families and communities. Women and girls might face ostracism or even death if they have (or are suspected of having) sexual relations outside of the rules enforced by society, such as before marriage. Furthermore, in certain societies, early marriage is utilised as a type of erroneously understood “protective” strategy to prevent the humiliation and penalties of a girl who had sexual relations before to marriage. As a result, some girls may be married off early in order to prevent any form of sexual activity before to marriage.

 

Medical Relevance: is ‘Virginity Testing’ a Determinant for Vaginal Intercourse?

According to a 2014 WHO article, the intrusive and demeaning “virginity test” or “two-finger test,” which is still employed in some countries to “verify” whether a woman or girl is a virgin, has “no scientific basis.” “The WHO guideline endorses the generally established medical position that ‘virginity tests’ are meaningless” and give no proof of whether a woman or a girl has had sexual intercourse or has been raped.

In reality, some women are born without a hymen, and the membrane can burst or stretch as a result of other activities like as athletics and weight lifting, among others.

The vaginal hymen is part of the vulva, or external genitalia, and is placed 1-2 cm within the vaginal entrance. Its structure is similar to that of the vagina in that it resembles a ruffled wreath and is made up of folds of mucous tissue that can be firmly or loosely folded. The form, size, colour, and flexibility of the hymen vary across women and during a woman’s life, depending on age, stage of sexual development, and hormone levels.

Talking About ‘Virginity Testing’ with Women and Girls

In some of these Syrian communities, young girls and women contact medical institutions and request ‘virginity testing.’ Many physicians find it difficult to deny when this occurs; they believe that if the request comes from the lady or girl herself, it is their obligation to do the test. It is critical to note that regardless of who demands the examination, the medical (in) validity of the test, as well as the human rights consequences, remain unchanged. Furthermore, the grounds for such a request are rooted in power disparities between men and women, as well as gendered cultural norms.

The individual requesting the test is most likely unable to fully exercise her right to freedom of choice, and the pressure placed on her to establish her ‘virginity’ is a violation of her rights in and of itself.

It is also vital that women and girls are targeted with awareness-raising messages in order to empower them and prevent them from feeling compelled to engage in this destructive activity.

Doctors, midwives, nurses, and psychosocial workers who hear these requests should perform the following:

  • Welcome the woman pleasantly, make her feel at ease, and ensure her that everything she says them will be kept private.
  • Determine the cause (why the woman thinks she needs such a test). Listening actively and respectfully to the woman or girl may result in the discovery of an abusive or dangerous scenario that must be handled with according to protocol.
  • Share with the lady the reasons why the test is not scientifically trustworthy, why it is a practise that must be ended, and specifics about its harmful practises (i.e. creating shame and fear to enforce control over women and girls).
  • Do not do the test; instead, assist the woman or girl in identifying alternate solutions (such as referral to case workers and devising safety plans) to the position she is in, ensuring her safety and security at all times.

Because virginity is not a medical condition, a medical examination is not necessary nor beneficial, and it may be both uncomfortable and detrimental.

Helping Women and Girls Who Have Been Subjected to ‘Virginity Testing’

Women and girls who are subjected to ‘virginity testing’ will respond differently to the examination, based on a variety of circumstances such as their age, current coping strategies, and/or social standing. Organizations should explore support interventions on a case-by-case basis and in accordance with the interests of the women or girls. Organizations with continuing case management programmes can guide women and girls who have disclosed having had a “virginity test” through several processes. Medical and emotional care, at a minimum, should be offered to these women and girls, either directly or through referrals to service providers delivering GBV-focused services.

Virginity and Pregnancy

Content
1 Virginity
2 Definitions
3 Hymen
4 Medico-Legal Aspect of Virginity
5 Pregnancy
6 Medico-Legal Aspect of Pregnancy

VIRGIN:
A virgin is a woman who has not experienced sexual intercourse.
Virgin term is derived from a latin word Virgo or Maiden, which means sexually inexperienced woman ( virgo intacta)

VIRGINITY
Virginity is the state of being Virgin.
Defloration
Latin Term – de:flore, flower and away: Rupture of hymen by sexual intercourse to the plucking of flower.
Defloration means loss of virginity
Marriage
It is a contract between man and woman which implies physical union by coitus.
Divorce
Divorce means dissolution of previously valid marriage
Chastity
It does not imply virginity
Chastity derived from a Latin word’ castitas meaning cleanliness or purity.
Hymenoplasty
It is an operation for repairing ruptured hymen. It will restore to its intact estate.
Hymenorrhaphy
• ‘Hymen’ is a Greek term meaning membrane and ‘Raphe’ means suturing:
• so, suturing of ruptured hymen is Hymenorrhaphy.
Hymenotomy
It is a surgical procedure to correct imperforate or septate Hymen.

CONCEPTS

The question of virginity arises in cases of-

1.Nullity of marriage:
• When either party was under age at the time of marriage
• One party was of unsoundmind or mental defective at the time of marriage
• Either party was already validly married,
• When female was pregnant by another man at the time of marriage or
• where has not been comummuted due to impotence or wilful refusal.

2.Divorce
The ground of the divorce are:
• Adultery,
• Incurable mental illness,
• Husband found guilty of rape,sodomy or bestality,
• Incurable leprosy
• Incurable venereal disease,
• deserted petitioners for two year continuously.
• Not heard for years and
• Divorce by mutual consent on the ground of living separately for one year or more

HYMEN
The Hymen is a fold of mucous membrane about 1mm thick, derived from the posterior vaginal wall, situated at the vaginal outlet.
Types of Hymen :
1.Annular Hymen: The opening is oval and situated near the centre of the membrane
2.Semilunar or Crescentic Hymen: It is commonest type of hymen in which the opening placed anteriorly.
3.Cribriform Hymen: There are several hymenal opening
4.Septate Hymen: Two lateral opening which is separated either partially or completely by a thin strip of tissue.
5.Vertical Hymen: The opening in the hymen is vertical.
6.Infantile Hymen: A small linear opening in the middle of hymen
7.Imperforate Hymen: No Hymenal opening present.
8.Fimbriated Hymen: This type of hymen is also called Frilly Edged Hymen’.

Causes of Rupture of Hymen
1.Act of coitus: Sexual inter course is the commonest cause of rupture of Hymen.
However in some cases Hymen remains intact inspite of Virgin, repeated sexual intercourse, such condition is called False
2.Accident: A fall on a projecting substance.
3.Foreign Body: Sola pith is introduced into vagina for rendering very young girl fit for sexual intercourse is called Aptae Virus.
4.Masturbation: Specially, if practiced with some large foreign body.
5.Surgical Procedure: Artificial maneuvers and gynecological examinations and introduction of instrument for medical examination.
6.SanitaryTampons: Insertion of sanitary tampon
7.Ulceration: Due to diphtheria and other diseases
8.Scratches: Due to irritation of parts the cause is lack of cleanliness.

Medico Legal Aspects
1.The presence of an intact Hymen is not an absolute sign of virginity. With an intact hymen there are true virgin or false virgin.
The principal signs of virginity are an intact Hymen, a normal condition of the fourchette and posterior commissure and a narrow vagina with rugosity of wall.
2. After repeated sexual intercourse, tears are present at 5’o clock and 7o’ clock position. After the birth of child Hymen is completely lost and small round flashy tags are formed called carunculae hymenales or ‘carunculae myrtiformes’.

PREGNANCY
Pregnancy is the carrying of one or more embryo or feotus inside the womb of a female.
The condition of having a developing embryo or feotus in the female occurs when an ovum is fertilized by a spermatozoon; in lay term it is called conception. The fused product of male and female gamete is called zygote. It occurs during reproductive period of female from 15 years to 45 years.
Although pregnancy begins with implantation, the process leading pregnancy occurs earlier as a result of female gamete or oocyte, merging with male gamete or spermatozoon.

Medico Legal Aspects
1.When a woman pleads pregnancy to avoid attendance in the court as a witness – Pregnancy itself is not an excuse, unless in advanced stage of pregnancy to the fact that delivery is imminent.
2.When a female sentenced to death penalty, pleads that she is pregnant to avoid execution. The High court has the to postpone the execution of death until 6 months after delivery or commute it to life imprisonment.
3.When a woman feigns pregnancy after her husband’s death to claim succession to estate.
4.When a woman, who had filed a suit in the court for breach of promise of marriage of seduction claims to be pregnant.
5.When a woman blackmails a man and accuses that she is pregnant by him to compel marriage.
6.In allegations that widow or an unmarried woman or a married woman living separately from her husband, is pregnant.
7.When a woman alleges that she is pregnant in order to secure greater compensation from some person dies through the negligence.
8.In case of divorce, the woman may claim to be pregnant to receive more alimony or maintenance /allowance.

 

 

Pre-Interview Written test for the post of Staff Nurse BPS-16 Health Department Government of Sindh.

Answer Key

Question Paper – 2015 (http://nursingipd.com/2022/04/02/1383/

1. A
2. B
3. C
4. A
5. C
6. A
7. C
8. B
9. C
10. B
11. A
12. C
13. B
14. D
15. C
16. D
17. B
18. A
19. B
20. C

21. B
22. C
23. D
24. C
25. D
26. C
27. C
28. C
29. D
30. A
31. B
32. D
33. D
34. D
35. C
36. B
37. D
38. A
39. A
40. C

41. D
42. C
43. C
44. A
45. A
46. D
47. B
48. C
49. B
50. C

51. D
52. B
53. D
54. C
55. D
56. A
57. D
58. B
59. D
60. B
61. A
62. B
63. D
64. B
65. A
66. B
67. D
68. C
69. A
70. B

71. D
72. B
73. A
74. B
75. B
76. B
77. B
78. B
79. A
80. C
81. B
82. C
83. D
84. B
85. C

86. D
87. C
88. B
89. C
90. B
91. B
92. C
93. B
94. B
95. C
96. B
97. B
98. A
99. D
100. C

For question paper, click on this link:

Pre-Interview Written test for the post of Staff Nurse BPS-16 Health Department Government of Sindh.

Pre-Interview Written test for the post of Staff Nurse BPS-16 Health Department Government of Sindh.

Tuesday 06th October 2015 Time: 01:00pm to 02:30pm Maximum Marks 100

QUESTION PAPER

1) Which One of the following drug may cause peptic ulcer:
(A) Aspirin (B) Paracetamol (C) Vitamin C (D) Doxycycline
2) Typhoid fever is caused by:
(A) E-Coli (B) Salmonella Typhi (C) Plasmodium (D) Parasite
3) Nursing Intervention for pre-operative preparation of patient are as follows, except:
(A) Decrease anxiety
(B) Assess patient to understand per and post-operative events
(C) Teach patient to perform deep breathing and leg exercises
(D) Propose appropriate surgical procedure
4) Improving Sanitation in a Village is:
(A) Primary prevention
(B) Primo Moto
(C) Secondary prevention
(D) Not a prevention measure
5) Mandatory test for Tuberculosis is
(A) X-ray chest
(B) Sputum for bacterium
(C) Tuberculosis test “D”
(D) Scan of chest
6) Edema is defined as excessive accumulation of:
(A) Interstiscial fluid
(B) Intravascular fluid
(C) Peritoneal fluid
(D) Lymphatic fluid
7) Collapse otherwise normal lung tissue is termed as
(A) Asthma
(B) Tuberculosis
(C) Atelectasis
(D) Pneumonia
8) Host is infected, but does not become functionally infection & thus does not transmit on to
(A) Obligate host
(B) Definitive host
(C) Intermediate host
(D) Dead and host
9) Stomatitis is inflammation of:
(A) Rectum
(B) Vagina
(C) Oral cavity
(D) Esophagus
10) Hypertension is most common due to
(A) Renal Disease
(B) cardiovascular disease
(C) Endocrinal cause
(D) Idiopathic

11) A lady is suffering from chronic renal failure, her blood will mostly lack in
(A) Erythrocytes
(B) Neutrophils
(C) Monocytes
(D) Lymphocytes
12) A baby boy is born after C section of three-kilogram weight with APGAR score is 9 out of 10 what you will take being on duty medical assistant:
(A) Cut the umbilical cord
(B) Suction of mouth and Nostrils
(C) Give to mother for breast feeding
(D) Give bath
13) The Ideal BMI of a person is:
(A) 14-19
(B) 20-25
(C) 26-29
(D) 30-35
14) The best position of a mother in first stage of labor is
(A) Lithotomy
(B) Supine
(C) Knee-chest
(D) Left lateral
15) Maximum score in Glasgow-coma scale is:
(A) 5
(B) 10
(C) 15
(D) 20
16) A patient is has come from Sukkur, is reported to have generalized aches, pain and rashes on palms and soles. The most likely diagnosis is:
(A) Scarlet fever
(B) Trypanosomiasis
(C) Malaria
(D) Dengue
17) Which one of the following is good cholesterol for consumption:
(A) LDL
(B) HDL
(C) VLDL
(D) Triglycerides
18) Following is true regarding chlorination, except:
(A) Contact period -30 minutes
(B) Free chlorine 0.5 mg/liter from one hour
(C) Water should not be turbid
(D) Chlorine demand should be estimated
19) The drug commonly used to manage the cardiac arrhythmias is:
(A) Ventolin (B) Digoxin (C) ceftriaxone (D) Metformin
20) Best indicator of air pollution is:
(A) Lead (B) Dust (C) carbon monoxide (D) Rust
21) Which of the following is not a function of nervous tissue:
(A) Conduction (B) Contraction (C) Integration (D) coordination
22) Which type of worm cause the iron deficiency anaemia:
(A) Thread worms (B) Round worms (C) Hook worms (D) Tape worms
23) All are soil mediated infections, except:
(A) Whipworm (B) Hook worms (C) Round Worms (D) Tape worms
24) Following are sign of labor, except:
(A) Painful uterine contraction
(B) Watery vaginal discharge
(C) Show
(D) Descend of fetal
25) The nursing management of cancer patient receiving chemotherapy include all, except:
(A) Prevention of infection
(B) Management of bleeding
(C) Patient education
(D) Change of chemotherapy
26) Leading cause of diarrheal disease in:
(A) Enterotoxgenic Escherichia Coli
(B) B. Salmonella (non-typhoid)
(C) Rota Virus
(D) D. Campylobacter
27) For diagnosis of pulmonary tuberculosis, the sputum of AFB should be examined for:
(A) One day (B) Two days (C) Three days (D) Four days
28) The change occurring in the disease frequency over many years is called:
(A) Cyclical trend (B) Seasonal trend (C) Secular trend (D) None of these
29) HBV vaccine is given by the rout of:
(A) Subcutaneous (B) Intravenous (C) Intradermal (D) Intramuscular

30) Which of the following drug can only be given by intravenous rout:
(A) Calcium gluconate (B) Magnesium sulphate (C) Vitamin K (D) Vitamin D3
31) What is WHO recommended normal cholesterol level in human?
(A) 200 ml/dl (B) Below 200 ml/dl (C) Above 200 ml/dl (D) None of these
32) The blood which can be transfused without cross matching in patient which hemorrhagic shock,
(A) A Rh +ve (B) B Rh +ve (C) AB –ve (D) O Rh –ve
33) Which are the following is not a feature of Horner’s Syndrome
(A) Miosis (B) Ptosis (C) Hypohidrosis (D) Arthritis
34) The time from receiving the infection to the onset of infectiousness, i.e. the ability to transmit infection,
(A) Latency period (B) Window period (C) Infective period (D) Incubation period.
35) Following vitamins are absorbed from small intestine, except
(A) Vitamin A (B) Vitamin D (C) Vitamin C (D) Vitamin B 12
36) Sputum specimen in unconscious patient can be obtained by,
(A) Coughing (B) Postural drainage (C) tracheal aspiration (D) Aspiration syringe
37) In an outbreak of cholera in a village 2000 population, 20 cases have occurred and 5 died. Case fatality is:
(A) 1% (B) 5% (C) 10% (D) 25%
38) Saw tooth appearance in ECG shows:
(A) Atrial flutter (B) Atrial fibrillation (C) Heart block (D) Myocardial Infraction
39) Chicken pox is caused by:
(A) Herpes zoster (B) HPV (C) Rubella virus (D) Mumps
40) Pulmonary arty arises from
(A) Right atrium (B) Left atrium (C) Right Ventricle (D) Left ventricle
41) Following are complications of uncontrolled diabetes, except:
(A) Peripheral Neuropathy (B) Retinopathy (C) Microvascular Disease (D) Asthma
42) The minimum recommended dose of “free” residual chlorine in water for routine 3 chlorination,
(A) 10 mg/it after 1-hour contact
(B) 0.5 mg/it after ½ hour contact
(C) 0.5 mg/it after 1-hour contact
(D) 4 mg/it after ½ hour contact
43) Rickets is a disease caused by deficiency of,
(A) Vitamin A (B) Vitamin B complex (C) Calcium (D) Magnesium
44) Ground water has the following advantages, except:
(A) Likely to be free from pathogenic organism
(B) Usually required no treatment
(C) Supply is likely to be certain during dry season
(D) Likely pour
45) AIDS is a disease caused by:
(A) Virus (B) Bacteria (C) Fungi (D) Parasite
46) In which of the following congenital hyperbilirubinemia syndrome phenobarbital is indicated,
(A) Gilbert’s (B) Crigler Najjar (C) Dubbin Johnson (D) Rotor
47) The common type of anemia in pregnancy is,
(A) Megaloblastic (B) Iron Deficiency (C) Haemolytic (D) Aplastic
48) Fever is terms as high grade if it is :
(A) < 98° F (B) > 98° F (C) > 100 °F (D) > 104°F
49) Mumps is disease caused by:
(A) Thyroid gland (B) Parotid gland (C) Pituitary gland (D) parathyroid gland
50) Patient is in recovery room after surgery. The most important initial nursing intervention is:
(A) Check wound (B) Check urinary output (C) Check Vitals (D) Check skin color

51) Bluish discoloration of skin is called:
(A) Anemia (B) Jaundice (C) Dehydration (D) Cyanosis
52) Blood complete picture shows microcytic hypochromic anemia, that may be due to deficiency of:
(A) Folic Acid (B) Iron (C) Vitamin B12 (D) Iodine
53) The last system during fetal life to mature is:
(A) Cardiovascular system (B) Genitourinary system
(C) Respiratory system (D) Nervous system
54) If a patient develops reaction due to incompatibility of blood the early nursing intervention should be:
(A)Administer adrenaline (B) Give oxygen by mask
(C) Stop administration of blood (D) Administer atropine
55) Thyroxin is secreted from:
(A) Pituitary gland (B) Hypothalamus (C) Parathyroid gland (D) Thyroid gland
56) Beta blocker are contraindicated in management of hypertension in association with:
(A) Myocardial Infraction (B) Asthma (C) Diabetes (D) peptic ulcer
57) A person required blood transfusion after road accident, which of the following blood can’t be transfused to patient. His own blood group is A positive.
(A) A negative (B) O positive (C) O negative (D) AB positive
58) Enteral feeding is feeding through:
(A) Stomach tube (B) Nasogastric tube (C) Intravenous route (D) Oral route
59) In which condition breastfeeding is contraindicated in infant:
(A) Diabetes (B) Hepatitis (C) Diarrhea (D) Active Tuberculosis
60) Nursing care in gastroscopy include all, except:
(A) Explanation of procedure
(B) No fluid is given for 4 to 6 hours before surgery
(C) Antibiotic is administered ½ hour before surgery
(D) Dentures and jewellery is removed
61) The ability of a microorganism to produce disease in a shorter period of time with a very low dose even
(A) Pathogenicity (B) Virulence (C) Infectivity (D) None of these
62) The Common cause of vertigo, except:
(A) Meniere’s disease (B) Labyrinthitis (C) Acoustic neurons (D) Mastoiditis
63) Influenza pandemic occurs after every 7-10 years. This kind of disease distribution in time is known as:
(A) Secular (B) Short time fluctuation (C) Cyclical trend (D) Seasonal trend
64) Oxytocin is secreted by:
(A) Anterior pituitary (B) Posterior pituitary (C) Thyroid (D) Hypothalamus
65) Soma is part of:
(A) Neuron (B) Muscle fiber (C) Connectivity tissue (D)Epithelial tissue
66) Impersonal health care includes all, except:
(A) Mental and child health (B) Water supply
(C) School health (D) Occupational health
67) The integrity, principles, ethics, meaning and purpose in life, are said to be
(A) Physical dimension (B) Mental dimension
(C) Emotional dimension (D) Spiritual dimension
68) Diabetes mellitus is caused by deficiency of,
(A) Thyroxin (B) Calcitonin (C) Insulin (D) Spleen
69) Vesicovaginal fistula abnormal communication between,
(A) Bladder and vagina (B) Urethra and vagina
(C) Rectum and vagina (D) Ureter and vagina
70) Disinfection of living tissue is called:
(A) Sepsis (B) Antisepsis (C) Antibiotic (D) Bacterial

71) All are early manifestation of shock, except:
(A) Decrease in blood pressure (B) Rapid weak pulse
(C) Moist cold skin (D) Decreased Urination
72) Which of the following is not a fat soluble vitamin,
(A) Vitamin A (B) Vitamin C (C) Vitamin D (D) Vitamin E
73) Prevention of the emergence or development of risk factors in countries or Population group is not yet an appeared is known as:
(A) Primordial
(B) Primary prevention
(C) Secondary prevention
(D) Tertiary prevention
74) Purest water in nature is from
(A) Lakes (B) Rain (C) Spring (D) wales
75) Appendicitis is suspected from the blood complete picture showing raised,
(A) Neutrophils (B) Eosinophils (C) Basophils (D) Lymphocytes
76) P 5 stand for:
(A) Mountainous peak Nanga Parbat
(B) 5 permanent members of UN security
(C) A cruise missile
(D) Election manifesto of PPP
77) Who Coined the word Pakistan?
(A) Sir Syed Ahmed Khan
(B) Chaudhry Rehmat Ali
(C) Maulvi Fazalhaq
(D) Allama Iqbal
78) The first president of Pakistan under 1973 constitution was:
(A) Z. A. Bhutto (B) Chaudry fazal Illahi (C) Ghulam Ishaq khan (D) Farooq Laghari
79) A short history of Saracen’s is a famous book by Syed Amir Ali. What is the meaning of Saracen’s
(A) People of the east (B) Ethiopians (C) Umayyad (D) Fatimid
80) Hassan Ali Effendi established Sindh Muhammadan Association on the advice of:
(A) Quaid-e-Azam (B) G.M. Bhurgri (C) Justice Syed Ameer Ali (D) Mualana Ubaid

81) Theory of Relativity was first presented by:
(A) Max Planck (B) Albert Einstein (C) Shankar Acharya (D) Socrates
82) Constitutional history of India begins with:
(A) Arab rule (B) Mughal rule (C) Act of 1935 (D) Independence Act of India
83) Largest desert of the world is:
(A) Australian (B) Arabian (C) Gobi (D) Sahara
84) “Reconstruction of Religious Thought in Islam” is a modern classic written by:
(A) Abu Kalam Azad (B) Allama Iqbal (C) Dr. Zakir Hussain (D) Abdullah Yousef
85) Millennium Development Goals (MDG) set by UN ought to be achieved by the year:
(A) 2013 (B) 2014 (C) 2015 (D) 2016
86) The first man on the moon was an American astronaut in 1969, his name was:
(A) Michael Collins (B) Edwin Buzz Aldrin (C) Stephen King (D) Neil Armstrong
87) Edward Snowden worked for US secret service and now calls himself a “whistleblower”. They called him,
(A) A rogue employee
(B) An informer who listen to his conscience
(C) A Spy
(D) Govt. Employee
88) The Simla delegation called on Lord Minto, the Viceroy of India, in October 1906, the delegation Led by:
(A) (A) M.R. Ghandi (B) Sir Agha Khan (C) Allama Iqbal (D) Sir Saleem ullah Khan
89) Shah Abdul Latif Bhittai’s ‘Risalo’ was first published by Dr. Ernest Trump From:
(A) Paris (B) London (C) Leipzig (D) Bombay
90) Who is the author of great English epic “Paradise Lost”?
(A) Shakespeare (B) Milton (C) Wordsworth (D) Tennyson
91) In 1847 the province of Sindh was divided in how many collectorates?
(A) Five (B) Three (C) Four (D) Six
92) Sindh became a separate province after 1935 Act of India and was separated from Bombay Presidency from the year?
(A) 1935 (B) 1937 (C) 1936 (D) 1939
93) Gomal Zam Dam was inaugurated in 2013 at:
(A) North Waziristan (B) South Waziristan (C) Upper Dir (D) Skardu
94) After the abolition of One unite scheme, in which year Sindh regained the provincial status?
(A) 1969 (B) 1970 (C) 1973 (D) 1968
95) RADAR was invented in 1935 as a way of locating enemy aircraft. Its inventor was:
(A) Frank Morris (B) Mortimer Wheeler (C) Robert Watson-Watt (D) James Martin
96) Grammar can be defined as:
(A) Art of politics
(B) Rules to combine works into larger unite of language
(C) Science of oratory
(D) Composing poetry
97) “In Black and White” Means:
(A) A movie in two colours (B) In writing (C) Without doubt (D) On the spot
98) “A rolling stone” means?
(A) A person who does not stay at one place
(B) A Criminal (C) A jester (D) An Actor
99) The vast alluvial plains laying between the western banks of Manchar lake and Kirthar range is?
(A) Kachu (B) Kohistan (C) Kaachho (D) Indus Delta
100) After the conquest of Sindh in 1843 the first British Governor of Sindh was:
(A) Sir John Jacob (B) Sir Charles Napier (C) Bartle Frere (D) Richard Burton

For answer key, click on below link: 

Pre-Interview Written test for the post of Staff Nurse BPS-16 Health Department Government of Sindh.

Appendicitis

Introduction:

Appendicitis is an inflammation of the appendix.
It is a medical emergency that usually leads to removal of the appendix before it can rupture, as this can cause infection and even death.
Surgically removing the appendix appears to have no effect on the digestive system.
Appendicitis can occur at any age but usually affects children and young adults.
Appendicitis is found on the right lower side of the abdomen and connects to the cecum of the large intestine. It looks like a protruding worm or finger-like structure coming out of the large intestine, specifically the ascending colon.
The role of the appendix: it plays a role in storing the “good” bacteria in your GI tract while the tract is recovering from a diarrhea illness (so it helps maintain healthy GI flora.

Types of Appendicitis
The two types of appendicitis depending on the onset, which are:

  • Acute Appendicitis – It develops very fast within a few days to hours, and requires prompt medical treatment or surgery.
  • Chronic Appendicitis – Here, the inflammation lasts for a long time. It is a rare condition.

And depending on the complications:

  • Simple Appendicitis – Cases with no complications.
  • Complex Appendicitis – Cases that involve complications like appendix rupture or abscess.

Causes
The exact causes are not clear, but it usually involves:

  • a blockage of the lumen of the appendix (leading to increased pressure and impaired bloodflow, which results in inflammation).
  • This is usually caused by faeces, but bacterial or viral infections in the digestive tract can lead to swelling of lymph nodes (lymphoid hyperplasia), which puts pressure on the appendix and causes obstruction.
  • Untreated, the appendix can become gangrenous or rupture. If it ruptures, the infection may be released into the abdomen.
  • inflammatory bowel disease.
  • stool, parasites, or growths that can clog your appendiceal lumen.
  • trauma to your abdomen.

Pathophysiology
Appendicitis occurs when the appendix becomes acutely inflamed. It’s not entirely known why appendicitis occurs however it is thought to be due to the lumen of the appendix becoming blocked by a faecolith, normal faecal matter or lymphoid hyperplasia due to a viral infection.

https://teachmepaediatrics.com/wp-content/uploads/2018/10/Appendicitis-e1540220601487-1024x733.jpeg Once obstructed, there is reduced blood flow to the tissue and bacteria is able to multiply. Due to the lumen being obstructed, the pressure within the appendix increases and this reduces venous drainage, resulting in ischaemia. If untreated the ischaemia can lead to necrosis and gangrene. At this stage, the appendix is at risk of perforating. It takes around 72hrs for perforation to occur from when the appendix becomes obstructed. Once the appendix perforates, bacteria and inflammatory cells are released into the surrounding structures. This then causes inflammation of the peritoneum and the child develops peritonitis causing diffuse abdominal pain.

Signs and Symptoms of Appendicitis

Remember “Appendix”

  • Abdominal pain (will be dull at first with pain at or around the belly button that radiates to the right lower quadrant and it will localize at this spot)
  • Point of McBurney’s will have the most pain (found one-third distance between the belly button and anterior superior iliac spine)
  • Poor appetite
  • Elevated temperature
  • Nausea/vomiting
  • Desire to be in the fetal position to relieve pain (side lying with knees bent)
  • Increased WBC, inability to pass gas or have a bowel movement (constipation..can have diarrhea too)
  • eXperiences rebound tenderness (when pressure is applied to the right lower quadrant it hurts but it HURTS MORE when the pressure is released) and abdominal rigidity on palpation (involuntary stiffening of the abdominal muscle when abdomen palpated).

Complications

If appendicitis is left untreated, a complication could occur.

Perforation of the appendix. This is a major complication of appendicitis, which can lead to peritonitis, abscess formation, or portal pylephlebitis.
Perforation generally occurs 24 hours after the onset of pain.
Symptoms include a fever of 37.7⁰C or greater, a toxic appearance, and continued abdominal pain or tenderness.

Assessment and Diagnostic Findings
Diagnosis is based on the results of a complete physical examination and on laboratory findings and imaging studies.

  • CBC count: A complete blood cell count shows an elevated WBC count, with an elevation of the neutrophils.
  • Imaging studies: Abdominal x-ray films, ultrasound studies, and CT scans may reveal a right lower quadrant density or localized distention of the bowel.
  • Pregnancy test: A pregnancy test may be performed for women of childbearing age to rule out ectopic pregnancy and before x-rays are obtained.
  • Laparoscopy: A diagnostic laparoscopy may be used to rule out acute appendicitis in equivocal cases.
  • C-reactive protein: Protein produced by the liver when bacterial infections occur and rapidly increases within the first 12 hours.

Medical Management
Medical management should be performed carefully to avoid altering the presenting symptoms.

  • IV fluids: To correct fluid and electrolyte imbalance and dehydration, IV fluids are administered prior to surgery.
  • Antibiotic therapy: To prevent sepsis, antibiotics are administered until surgery is performed.
  • Drainage: When perforation of the appendix occurs, an abscess may form and patient is initially treated with antibiotics and the surgeon may place a drain in the abscess.

Surgical Management
Immediate surgery is typically indicated if appendicitis is diagnosed.

  • Appendectomy. Appendectomy or the surgical removal of the appendix is performed as soon as it is possible to decrease the risk of perforation.
  • Laparotomy and laparoscopy. Both of these procedures are safe and effective in the treatment of appendicitis with perforation.

Nursing Management

  • A focus of the nurses’ management is the preparation of the patient for surgery.

Nursing Assessment

Assessment of a patient with appendicitis may be both objective and subjective.

  • Assess the level of pain.
  • Assess relevant laboratory findings.
  • Assess patient’s vital signs in preparation for surgery.

Diagnosis
Based on the assessment data, the most appropriate diagnoses for a patient with appendicitis are:

  • Acute pain related to obstructed appendix.
  • Risk for deficient fluid volume related to preoperative vomiting, postoperative restrictions.
  • Risk for infection related to ruptured appendix.
  • Planning & Goals
  • Main Article: 4 Appendectomy Nursing Care Plans

Goals for a patient with appendicitis include:

  • Relieving pain.
  • Preventing fluid volume deficit.
  • Reducing anxiety.
  • Eliminating infection due to the potential or actual disruption of the GI tract.
  • Maintaining skin integrity.
  • Attaining optimal nutrition.

Nursing Interventions

  • The nurse prepares the patient for surgery.
  • IV infusion. An IV infusion is made to replace fluid loss and promote adequate renal functioning.
  • Antibiotic therapy. Antibiotic therapy is given to prevent infection.
  • Positioning. After the surgery, the nurse places the patient on a High-fowler’s position to reduce the tension on the incision and abdominal organs, thereby reducing pain.
  • Oral fluids. When tolerated, oral fluids could be administered.

Evaluation

  • Relieved pain.
  • Prevented fluid volume deficit.
  • Reduced anxiety.
  • Eliminated infection due to the potential or actual disruption of the GI tract.
  • Maintained skin integrity.
  • Attained optimal nutrition.

Discharge and Home Care Guidelines

Discharge teaching for patient and family is imperative.

  • Removal of sutures. The nurse instructs the patient to make an appointment with the surgeon to remove the sutures between the 5th and 7th days after surgery.
  • Activities. Heavy lifting is to be avoided postoperatively; however, normal activity can be resumed within 2 to 4 weeks.
  • Home care. A home care nurse may be needed to assist with incision care and to monitor the patient for complications and wound healing.

Documentation Guidelines

The focus of documentation in patients with appendicitis should include:

  • Client’s description of response to pain.
  • Acceptable level of pain.
  • Prior medication use.
  • Results of laboratory tests.
  • Surgical site.
  • Signs and symptoms of infectious process.
  • Recent or current antibiotic therapy.
  • Plan of care.

Teaching plan.

  • Response to interventions, teaching, and actions performed.
  • Attainment or progress toward desired outcomes.
  • Modifications to plan of care.

Long term needs.

Nursing Intervention

Preoperative interventions

  • Maintain NPO status.
  • Administer fluids intravenously to prevent dehydration.
  • Monitor for changes in level of pain.
  • Monitor for signs of ruptured appendix and peritonitis
  • Position right-side lying or low to semi fowler position to promote comfort.
  • Monitor bowel sounds.
  • Apply ice packs to abdomen every hour for 20-30 minutes as prescribed.
  • Administer antibiotics as prescribed
  • Avoid the application of heat in the abdomen.
  • Avoid laxatives or enema.

Postoperative interventions

  • Monitor temperature for signs of infection.
  • Assess incision for signs of infection such as redness, swelling and pain.
  • Maintain NPO status until bowel function has returned.
  • Advance diet gradually or as tolerated or as prescribed when bowel sound return.
  • If ruptured of appendix occurred, expect a Penros drain to be inserted, or the incision maybe left to heal inside out.
  • Expect that drainage from the Penros drain maybe profuse for the first 2 hours.

Frequently Asked Questions

1. How Do You Rule Out Appendicitis?

  • Appendicitis can be ruled out by using brief case history, physical examinations, computed tomography scan, urine analysis, ultrasound abdomen, anal examinations, an x-ray of the abdomen, and blood examination.

2. How Long Can You Have Appendicitis Before It Bursts?

  • The duration taken for bursting depends on the type of appendicitis. In the case of chronic appendicitis, it lasts for a long period, whereas in the case of acute conditions, symptoms will appear suddenly and immediate surgery is needed.

3. What Does Appendicitis Feel Like?

  • Appendicitis pain might be mild or severe. There will be fever, abdominal pain, navel pain, difficulty in moving around, loss of appetite, and anal pain in some cases. There may also be vomiting, diarrhea, and nausea.

4. How Bad Is Appendicitis Pain?

  • There will be sharp pricking pain in the abdomen and the pain worsens by pressing the painful area, moving around. Sometimes, even coughing, and sneezing worsens the pain. There will be difficulty in sitting in a particular place for a long time. There will also be difficulty in passing urine.

5. How Do You Check for Appendicitis at Home?

  • There are no standard methods for the examination of appendicitis at home, but we can check for any swelling in the abdominal area. If we have basic knowledge and ideas about appendicitis we can palpate the abdomen and rule out in some cases.

6. How Does Someone Get Appendicitis?

  • Any blockages in the lining of the appendix lead to appendicitis. This is mainly due to the food items we consume and seeds of fruits that block the passage. It may lead to infection and rupture in the appendix region and sometimes pus discharges also.

7. Should You Feel for Appendicitis?

  • Appendicitis treated at an early time is easily curable but in cases where it is left untreated leads to fatal conditions. So, it is necessary to start the treatment faster. This will make the condition simple.

8. How Does Appendicitis Pain Start?

  • The pain usually comes and goes for a short period of time in the belly and navel region. It starts with pain around the navel region which makes it difficult in sitting and moving. If you are feeling too much pain, you should consult your doctor immediately.

9. What Is the Recovery Time for Appendicitis?

  • Usually, it takes around one to three days for recovery for laparoscopy. It usually takes two to four weeks after surgery to return to our routine life. Depending on the severity of the surgery, and the patient the recovery time may be extended. You should ask your doctor for instructions that are to be followed.

10. How Quickly Does Appendicitis Come On?

  • Appendicitis comes so quickly that symptoms appear within the first 24 hours. Later on, any disturbance and food items lead to further signs and rupture. Any disturbance to the regions leads to further signs.

11. How Long Are a Patient Stays in the Hospital for Appendicitis?

  • The patient stays in the hospital just for three days. The patient is admitted to the hospital one day before the surgery. This is done so that the patient can adapt to the environment before the surgery. The next day surgery is performed. The patient is asked to stay in the hospital for another day and then they can be discharged if the doctor advises them to do so.

12. How Quickly Does Appendicitis Develop?

  • The degree of pain and the duration it takes to show the symptoms might vary. Appendicitis usually develops in teenagers, the symptoms appear very early in addition some food items lead to rupture of the appendix. Symptoms and signs appear in an early stage. However, you should consult your doctor if you experience pain for more than one day.

13. Where Does Your Stomach Hurt With Appendicitis?

  • Initially, the pain starts near the belly and in the navel region, and later on the pain travels to the abdominal region, mainly to the right abdomen. There will be swelling in the stomach region which can be identified by palpation by the doctors. Palpation is the procedure of investigation done by touching and pressing.

14. What Is Appendicitis Surgery?

  • For severe cases of appendicitis, appendectomy is done. It is the surgical removal of the appendix. This is usually done by open surgery. Nowadays, it is done using a laser. The surgery that is done using a laser is known as laparoscopy. In which three holes are made and the further procedure is carried out.

15. What Foods Make Appendicitis Worse?

  • Undigested food makes the condition of the appendix to worsen. Seeds of fruits and vegetables are also harmful. Medications that are taken to relieve pain leads to the rupture of the appendix. This makes the condition even worsen. Some doctors say that spicy food items also worsen the condition of appendicitis.

16. What are the early signs and symptoms of appendicitis?

The signs and symptoms of appendicitis are:

– Nausea.

– Vomiting.

– Loss of appetite.

– Sudden and severe pain in the right side of the lower abdomen.

– The pain begins in the navel that shifts to the right side of the abdomen.

– Severe pain will be experienced while walking, coughing, and movements.

References:

https://nurseslabs.com/appendicitis/

http://nursingfile.com/nursing-care-plan/nursing-interventions/nursing-interventions-for-appendicitis.html

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/appendectomy

https://www.healthline.com/health/appendicitis#tests

https://www.icliniq.com/articles/gastro-health/appendicitis

https://teachmepaediatrics.com/surgery/abdominal/acute-appendicitis/

First Aid

Wound: Abnormal break in skin which permits the escape of blood, and may allow the entrance of germs, causing infection.

Types of Wound:

  1. Incise Wound – Clean cut caused by sharp instrument.
  2. Laceration Wound – Jagged cut or tear caused by sharp irregular edges.
  3. Contusion – Caused by blunt instrument / fall against hard surface. Skin is not broken.
  4. Abrasion – Simple scrapes and scratches usually from a sliding fall.
  5. Puncture Wound – Penetrating wound by sharp, pointed instrument. Can result in serious internal injury.
  6. Stab Wound – Caused by a bladed object.
  7. Gun Shot Wound

Ways to Stop Bleeding:

  1. Direct pressure
  2. Indirect pressure
  3. Elevation

Wound Management:
Slight Bleeding
-Wash your hands and wear a pair of gloves.
– Rinse wound with running water.
– Dab gently to dry.
– Apply direct pressure or elevation if bleeding still occurs.
– Cover wound with sterile swab.
– Clean surrounding area of skin with water and soap.
– When cleaning, wipe away from wound and use each swab only once.
– Avoid wiping away blood clots.
– Pat dry.
– Dress wound with adhesive dressing.

Severe Bleeding
Aim of managing severe bleeding: a) control bleeding b) minimize risk of infection
– Lay casualty down to prevent shock.
– Support injured part.
– Send to hospital.
– Wash hands.

Bandaging:

  1. Triangular bandage (Reef Knot – L over R; R over L)
  2. Broad bandage
  3. Narrow bandage

Slings and Bandaging:

  1. Simple sling
  2. Elevated sling
  3. Scalp bandage
  4. Palm bandage
  5. Fist bandage

Fracture: A break or crack in the bone caused by direct force and indirect force.

Type:

  1. Closed or simple fracture (no wound)
  2. Open or compound fracture (wound is present)
  3. Comminuted (totally crushed)
  4. Green stick injury (In children; mixture of bend and break)
  5. Unstable fracture

Management of Closed Fractures:

  1. Do not move the casualty until you support the injured part.
  2. Steady and support the injured part.
  3. Immobilize the injured part using bandages and slings.
  4. Elevate the injured part.
  5. Treat for shock if possible.
  6. Check circulation every 10 minutes.
  7. Send to hospital.
  8. Do not give him anything to eat or drink.

Management of Open Fractures:

  1. Cover wound with sterile / clean dressing.
  2. Control bleeding.
  3. If wound is jutting, place padding.
  4. Immobilize the injured part.

Dislocation: Displacement of a bone at a joint caused by strong force, wrenching the bone into an abnormal position or violent muscle contraction.

Sprain: Injury to a ligament at or near a joint frequently caused by wrenching movement at joint that tears the surrounding tissue.

Strains: Partial tearing of the muscles at the junction of muscle and tendon that joins it to a bone.

Management of Sprain and Strains (Soft Tissue Injury):

R Rest
I Ice – Reduce swelling
C Compression
E Elevation

If injury is very bad, send the casualty to the hospital.

Cramps: Sudden, involuntary and painful muscle spasm.

Cramp in Foot:

  1. Ask casualty to stand on toes.
  2. Massage foot with fingers.

Cramp in Calve:

  1. Straighten the knee.
  2. Draw the foot firmly and steadily upwards towards the shin.
  3. Massage.

Cramp in Back of Thigh:

  1. Straighten the knee by raising his leg.
  2. Massage the muscles.

Cramp in Front of Thigh:

  1. Bend knee.
  2. Massage muscles slowly.

Signs & Symptoms:

  1. Difficult to move a limb
  2. Pain near the site of injury
  3. Tenderness
  4. Distortion
  5. Swelling
  6. Bruising
  7. Shortening, bending or twisting of the limb
  8. Crepitus (sound) caused by grating of the bone end

Lifting and Moving Casualty

Rules:

  1. Do not move casualty unless absolutely necessary.
  2. Explain to casualty what you are doing.
  3. Never move casualty alone.
  4. Instruct helpers what they are supposed to do.
  5. Protect yourself using the correct techniques.
  6. Ensure casualty’s safety.

Correct Lifting Techniques:

  1. Place feet comfortably apart, one slightly in front of the other.
  2. Keep back straight.
  3. Bend your knees.
  4. Grip with both hands.
  5. Keep weight of person you are lifting as close to you as possible.

Lifting Method:

Casualty is conscious and able to walk:

  1. Use the human crutch

Casualty is conscious but unable to walk:

  1. Pick-a-back
  2. Drag method
  3. 4 handed seat
  4. 3 handed seat
  5. 2 handed seat
  6. Fore & aft
  7. Carry chair

Casualty is unconscious:

  1. Cradle method
  2. Drag method
  3. Fore & aft
  4. Stretcher method

 

MULTIPLE SCLEROSIS

Multiple sclerosis (MS) is a chronic demyelinating disease that affects the myelin sheath of neurons in the CNS.

Multiple-Sclerosis-Infographic Multiple sclerosis is a disease that causes vision problems, numbness and tingling, muscle weakness, and other problems. It happens when the body’s infection-fighting system attacks and damages nerve cells and their connections in the brain and spinal cord.
When the body’s infection-fighting system, called the “immune system,” attacks the body’s own cells, it is called an “autoimmune response.” It causes damage to myelin, the protective coating around the nerves. When myelin is damaged, messages can no longer be clearly transmitted from the brain and spinal cord to other parts of the body. Many people refer to multiple sclerosis as “MS.”

INCIDENCE

  • Onset occurs between 20-40 years of age.
  • Women are more affected than men. (AANN, 2011).
  • Whites are more affected than Hispanics, blacks, or Asians.
  • Most prevalent in colder climates of North America & Europe.
  • Migration.

ETIOLOGY & RISK FACTORS

  • Exact cause is not known yet.
  • Most theories suggest that MS is an immunogenetic viral disease (with Epstein Barr virus).

 

Risk factors are:

  • Age (most of the time between 20-40 yrs).
  • Sex (women have more chance).
  • Family history (genetic susceptibility).
  • Certain infections (like Epsteinbarr virus).
  • Climate (more in cold climate areas).
  • Certain auto-immune diseases (higher risks with thyroid disease, type-1 DM or IBD).
  • Smoking.
  • Stress, fatigue.
  • Physical injury.
  • Pregnancy (may relating to stress to labour, or puerperium).

 

PATHOPHYSIOLOGY

Due to etiological factors
Activated T-cells (which recognise self Ag) expressed in CNS, &
Macrophages (B-cells) enters the brain from peripherral circulation
Production of inflammatory cytokines & reactive O2 species
Inflammation
Then activated T-cells & B-cells cause demyelination and destruction of oligodendrocytes
Formation of plaque Causes scarring & destruction of sheath
Compensatory system starts causing subsidation of edema & inflammation
After that some remyelination process occurs which is often incomplete Multiple sclerosis.

 

CLINICAL MANIFESTATIONS

The course of illness varies from person to person.

  1. Fatigue is the lack of physical and mental energy that impacts daily tasks. Fatigue can be physical or mental and is not correlated to how much rest or sleep a person gets. It is one of the most common symptoms and impacts about 80 percent of people living with MS. It can be http://nursingfile.com/wp-content/uploads/2013/12/multiple-sclerosis-249x300.jpg the most debilitating factor, even for those who have minimal physical restrictions, and is one of the leading causes for people leaving the workforce.
  2. Heat intolerance in MS is a temporary worsening of symptoms with elevated body temperatures including hot and humid weather, exercising, sunbathing, or fevers. A small rise in body temperature (a quarter to a half a degree) can cause increased fatigue, tingling, blurry vision, or even the inability to walk. Most people living with MS have to avoid outdoor activity and/or use cooling garments to complete simple, daily activities due to this intolerance.
  3. Cognitive dysfunction affects high-level brain functions such as memory, attention/concentration, the ability to solve daily problems, understand and use language, and process information from different senses. Impaired cognition affects 50-65 percent of those living with MS and is another major reason for leaving the workforce early.
  4. Pain/abnormal sensation is a common symptom with MS and can be directly related to neuropathic pain (the disease process itself) or from musculoskeletal pain (changes to the body and immobility). The pain experience is unique to each person and can greatly limit his or her ability to participate in and enjoy socialization and activities. Those living with MS can also experience various abnormal sensations such as numbness and tingling, prickling, sharp/stabbing pains, hot/cold sensations, and burning pains which can also impact movement and daily function.
  5. Depression comes in various forms and can be one of the most common symptoms in MS, more common in people with MS than the general population. Depression can happen to anyone at any time during the disease course and does not correlate to disease severity, however it can greatly impact someone’s quality of life and ability to participate in daily activities.

 

COMPLICATIONS

People with multiple sclerosis may also develop:

  • Muscle stiffness or spasms
  • Paralysis, typically in the legs
  • Problems with bladder, bowel or sexual function
  • Mental changes, such as forgetfulness or mood swings
  • Depression
  • Epilepsy

DIAGNOSTIC EVALUATION

  • There is no definitive test for MS.
  • Detailed history of episodes of neurologic dysfunction
  • Physical examination.

Other tests include:-

  • CSF evaluation (for presence of IgG antibody or oligoclonal bonding)
  • Evoked potentials of optic pathways & auditory system to assess presence of slowed nerve conduction.
  • MRI of brain and spinal cord (to determine the presence of MS plaques)
  • CT scan (to detect areas of demyelination, but with less detail as by MRI).

 

MEDICAL MANAGEMENT

• No exact cure.

• Aim is to prevent or postpone the long term disability (often evolves slowly over many years).

• The treatment falls into 3 categories:-

1. Treatment of acute relapses.

2. Treatment aimed at disease management.

3. Symptomatic treatment.

1. Treatment of acute relapse:-

  • Corticosteroid therapy ( anti-inflammatory & immunosuppressive property )
  • For example:
  • Methyl-prednisolone , (given I.V. or orally)
  • Azathioprine & cyclophosphamide (in severe cases)

2. Treat exacerbations:- (treatment aimed at disease management)

  • Interferon-Beta 1b
    • Betaseron, given subcutaneously. (antiviral & immuno-regulatory) (For ambulatory clients with relapsing –remitting).
  • Interferon Beta 1a
    • Avonex, (for treating replasing form of MS).
  • Glatiramer acetate
    • Copaxane, (for relapsing re-emitting MS).

3. Symptomatic treatment:-

  • For bladder dysfunction:
    • oxybutynin, propantheline.
  • For constipation:
    • psyllium hydrophilic mucilloid, suppositories.
  • For fatigue:
    • amantadine, modafinil .
  • For spasticity:
    • baclofen, diazefen, dantrolone.
  • For Tremor :
    • propanolol, phenobarbital, clonazepam.
  • For dysesthesias & trigeminal neurolgia:
    • carbamazepine, phenytoin, amitriptyline.
  • For dysesthesias:
    • Transcutaneous electrical nerve stimulation (TENS) is also helpful.

4. Nutritional therapy:-

  • Megavitamin therapy (cobalamin/vit. B12 and vit. C)
  • Low fat diet.
  • high roughage diet (to relieve constipation)

5. Other therapies:- (to improve neurological functioning)

  • Physical and speech therapies.
  • Exercise.
  • Water exercise.

 

SURGICAL MANAGEMENT

  • Deep brain stimulation:-
    • if other options have failed then a device is implanted that stimulates an area of brain. (in case of severe tremor in limbs).
  • Implantation of a drug catheter or pump:
    • a catheter is placed in lower spinal area to deliver a constant flow of drug like baclofen. (in case of severe pain or spasticity).

 

NURSING DIAGNOSIS:

    • Impaired physical mobility related to fatigue & weakness
    • Activity intolerance r/t weakness, dizziness, and unsteady gait
    • Self-esteem disturbance r/t loss of health & lifestyle changes

NURSING MANAGEMENT

    1. Promotes physical mobility – activity and rest
  • no vigorous physical exercise
  • frequent rest periods
  • walking and gait exercises
  • minimize spasticity and contractures – warm packs, daily muscle stretching
  • activities: swimming, stationary bike, progressive wt bearing
  • Minimize effects of immobility; skin integrity; cough and deep breathing exercises.
    1. Prevent injury – walk with feet wide apart, environment awareness and modification, gait training. Use of assistive devices – walker, cane etc.
    2. Promote bladder & bowel control – Urinal/bedpan readily available, po fluids intake schedule/voiding schedule, increase fiber in diet, intermittent self-catheterization
    3. Improve sensory and cognitive function:
  • Vision – eye patch for diplopia; prism glasses for reading; talking books
  • Speech – slurred, low volume, problems with phonation – speech therapist
  • Cognitive & emotional responses – forgetfulness, easily distracted, emotionally labile, social activities; hobbies.
    1. Development of coping strengths – education about diseases process; stress relief; network of services – social, speech, PT, psychological, homemaker/meal on wheels
    2. Improve self-care – assistive devices, raised toilet seat, shower bench, reached tongs, decrease physical and emotional stress, decrease exposure of extreme temperatures
    3. Adapting to sexual dysfunction – counseling, plan sexual activity, willingness to experiment.

Cancer

CANCER/NEO-PLASM/NEW GROWTH

  1. Cancer is also called neoplasm
  2. Cancer is also defined as abnormal growth in the tissue either slow (benign) & or fast (malignant)
  3. Cancer is the new growth, a tumor which is either cancerous or non-cancerous
  4. Abnormal mass that is referred as a neoplasm or new growth. The cells of the neoplasm serve the no useful purpose and use nutrients and oxygen
  5. Nursing involvement in the care of the patient education, assessment, monitoring, and treatment support and require knowledge of both the bio-medical and physiological components of the cancerous care.

Difference between the Benign & Malignant

Benign Malignant
1 Increase in size slowly Increases in size rapidly
2 Growth is limited as a capsule Growth is unlimited
shaped
3 Do not spread towards neighboring Spread towards neighboring tissue or
tissue or organ organ
4 Do not spread to a lymphatic system Spread to a lymphatic system
5 No tendency to re-occur, even after Tendency to re-occur, even after
surgery surgery
6 Benign is the opposite of the Malignant is the opposite of the Benign
malignant
7 Benign may re-occur if surgeon Malignant possess the property of the
can’t get successive result anaplasia
8 It can be treated with the medicines It cannot be treated with the medicines

Anaplasia= loss of distinctive characteristics of a cell associated with proliferate activity as in cancer.

Metastasis (Secondary Malignant)

  1. Secondary malignant is also called Metastasis
  2. Secondary Malignant is defined as the transfer of a disease from one part of the organ to the part throughout the blood vessels and lymph.
  3. Metastasis may occurs due to the primary Malignant
No: Tissue types Benign Malignant
A. Epithelial
i Surface skin Popilloma Squamous cell carcinoma
ii Glandular Adenoma Adino-carcinoma
i Fibrous Fibroma Fibro-carcinoma
ii Adipose Lipoma Lipo-carcinoma
iii Cartilage Chondroma Chondro-carcinoma
iv Bone Oestoma Oesteo-carcinoma

Common sites of Metastasis are lungs, liver, brain and bone.

  1. Connective
  2. Muscular
i Smooth Leiomyoma Leiomyo-sarcoma
ii Striated Rhambdomyoma Rhabdo-sarcoma
  1. Nerve
i Nerve Neuroma Neuro-blastoma
ii Gliel Glioma Glio-blastoma
iii Nerve sheath Neurilemmoma Neirilemmal-sarcoma
iv Menings Meningioma Meningeal-sarcoma
  1. Hematological
i Granulocytic Myelocytic leukemia
ii Erythrocytic Erythrocytic leukemia
iii Lymphocytic Lymphocytic leukemia
iv Monocytic Monocytic leukemia
v Plasma cell Multiple myeloma
  1. Endothelial
i Blood vessel Hemangioma Hemangio-sarcoma
ii Lymph vessel Lymphangioma Lymphagio-sarcoma
iii Lymph tissue Lymphogioma Lympho-sarcoma

Treatment of the neo-plasm:

At present three methods have proved their values in the treatment of the neo-plasm

  1. Chemo-therapy
  2. Radio-therapy
  3. Surgery

The hope for cure of neo-plasm especially for malignant depends on the chemotherapy. In general, it can be said that as yet no drugs have been discovered to cure malignant tumor however, cancer chemotherapy may or may not offer some help to patients for home surgery and radiation are no longer beneficial. Chemotherapeutic agents at the time of surgery may reduce or slow up the appearance of secondary growth. In some patients pain and other symptoms are relieved for the time.

Chemotherapeutic agents are especially used for the lymphomea and leukemia, diffuse tumor usually not amenable to surgical therapy.

The rational for administrating chemotherapeutic drug is that they are capable and destroying young rapidly multiplying cells. It is believed that these drugs interfere with the manufacturing of nucleic acid that is necessary for the building of genetic structures in the cells. As a result cellular growth and building reproduction inhabited.

Specific agents used as chemotherapy

  1. Poly-functional alkyl ting agents:

These poison destroy both cells either tumor cells or normal. It is believed that tumor cells are more sensitive to toxicity than normal cells, as a result cell growth and division is hindered.

The chief disadvantage of most of these drugs is destructive effect on the bone marrow, which is the body’s chief source of new born blood cells other side effect is vomiting, nausea and Stomatitis.

  1. Antimetabolytes:

e.g.: Folic acid, purine antagonistic

These are the synthetic substance, similar to those that nourish the normal cells during its growth and development.

  1. Steroids compounds:
  2. ACTH: control on cortisol (kidney).
  3. Castration: control on secretion on prostate gland.

These drugs changes the endocrine environment because tumor arising in organs usually under hormonal influences such as prostate and breast.

The patient receiving the type of therapy will be need to be observed by toxicity signs such as fluid retention, increases libido (the vital force or impulse which brings about purposeful action) and hirutism (excessive hair ness) as well as nausea and vomiting.

  1. Miscellaneous drugs:

Antibiotics drugs such as Actynomycin-D, Mytomycin-C and Streptomycin.

Note:

None of above drug can cure Malignancy. They are efforts to make the physiology of the host cells less favorable for the growth of the cancer.

These drugs may be given orally, IV, IM depending on the drug and Carcinoma.

Side effects of the chemotherapeutic drugs:

  1. Stomatitis
  2. Neuro toxicity
  3. Hepatic toxicity
  4. Ocular toxicity
  5. Diarrhea
  6. Nephro toxicity
  7. Bladder toxicity
  8. Oto toxicity
  9. Endocrinal changes
  10. Pulmonary toxicity
  11. Cardio toxicity

General Nursing & Medical care of the onco-patient (Cancerous-patient):

  • To control the Carcinoma growth by surgery, radiation and chemotherapy
  • Combats on local and systemic infection
  • Correct existing enema and electrolytic imbalance
  • Give the patient psychological support by the explaining the treatment by re-assurance, listen and observe the patient anxiety
  • Administrator vitamin-B as prescribed and blood transmission is needed
  • Give sedatives, anti-emetics, anti-histamines (allergic)
  • Offer small frequent feeding of high caloric
  • Increase fluid intake
  1. Report patient’s reaction response
  2. Control on diarrhea
  3. Remove constipation by giving low residue or balanced diet
  4. Give enema if required as suppository if needed
  5. Take care of skin especially of perineal area
  6. Apply oil or cream to radiation site.
  7. Protect skin from sun-light, heat, injury and tight clothing
  8. Advice for blood CP
  9. Protect the patient from the infection
  10. Evaluate the quality, intensity duration of pain as well as patient response to pain
  11. Promote the general comfort of patient by turning, moving and rest
  12. Administer drug as prescribed
  13. Use specific drug for nausea and vomiting
  14. Apply cold or hot compression if needed
  15. Apply local anesthetic to relieve the pain
  16. Prepare for alcohol injection to block narrow path
  17. Control on the odor and remove odor
  18. Encourage for good personal hygiene
  19. Give normal saline irrigation to external areas if required
  20. If administrator prescribed vaginal irrigation, when discharge of vaginal secretion of the patient
  21. Keep perineal area shaved
  22. Observe for increasing pulse rate
  23. Observe the amount and color of the blood if bleeding
  24. Apply digital pressure if site is accessible
  25. Apply vaginal or rectum packing if required
  26. Care the bladder frequently and incontinence
  27. Maintain I/O chart
  28. Insert catheter if all other measures fails
  29. Encourage patient for fluid & regular meal for constipation
  30. Reduce edema by ROM (range of motion)
  31. Evaluate edematic extremity
  32. Prevent the patient from bed sore by providing stimulation circulation
  33. Assess the patient to cope with his/her situation
  34. Develop a supportive relationship with patient (Psychotherapy)
  35. Encourage the patient to make decision
  36. Listen the patient attentively and answer the patient frequently and politely
  37. Provide a daily schedule to the patient
  38. Encourage the patient to be active
  39. Maintain the patient optimal physical, mentally and emotionally satisfaction
  40. Maintain a cheerful and optimistic attitude
  41. Encourage for verbalization
  42. Do little more for the patient
  43. Include the family in the patient’s care.

Side effects of the chemotherapeutic drugs:

  1. Stomatitis
  2. Neuro-toxicity
  3. Hepatic-toxicity
  4. Ocular toxicity
  5. Diarrhea
  6. Nephro toxicity
  7. Bladder toxicity
  8. Oto toxicity
  9. Hormonal changes
  10. Pulmonary toxicity
  11. Cardio toxicity
Cases of Neoplasm as re Registered in United Kingdom in 1985:
MALE FEMALE.
Lung 24% Lung 19%
Skin 12% Skin 09%
Prostate 09% Cervix 03%
Bladder 06% Ovary 04%
Colon 06% Colon 07%
Stomach 06% Stomach 04%
Rectum 05% Rectum 03%
Pancreas 03% Pancreas 02%
Esophagus 02% Breast 19%
Leukemia 02% Uterus 03%
Others 25% Other 37%
  1. Esophageal Carcinoma Definition:

Carcinoma of the esophagus is unique in its geographic distribution. Both benign & malignant tumor occurs in the esophagus. Benign tumor are usually leimyomas, and extremely rare & usually asymptomatic. They require no intervention unless symptoms necessitate local excision. Malignant tumors of the esophagus are not common but they assume increased importance because of their virulence.

Location of esophagus:

Esophagus lies behind the trachea to which it adopts and in front of the vertebral column. Passing through the thorax it pierces the diaphragm to enter in abdomen where it communicates with the stomach. Its size is 9-10 inches.

Causes:
© Exact cause is idiopathic,
© Pre-disposing factors are: © Taking alcohol
© Usage of tobacco and opium © Excessive usage of beverages
© Induced caustic esophagus sphincter © Ultra-violet radiations

  1. Tumor
  2. Dysphagia
  3. Odynophagia (typically)
  4. Heart burn
  5. Anorexia
  6. Weight loss
  7. Feeling mass in throat
  8. Painful swallowing
  9. Regurgitation
  10. Hiccup
  11. Chest pain
  12. Supera-clavicular lymphodenopathy

Complication:

  1. Hemorrhage
  2. Esophageal perforation
  3. Esophageal obstruction

Investigations:

  1. Chest X-ray
  2. CT scan
  3. Barium esophagography
  4. Bronchoscopy
  5. Biopsy
  6. MRI
  7. Blood CP

Medical treatment:

  1. Poly-functional alkyl ting agents:
  2. Antimetabolytes:
  3. e.g.: Folic acid, purine antagonistic
  4. ACTH
  5. Castration
  6. Miscellaneous drugs:
  7. Antibiotics drugs such as Actinomycin-D, Mytomycin

Surgical treatment:

  1. Surgical, the resection of the esophagus provides the most rapid durable relief of the Dysphagia, the standard surgical Management including partial removal of the esophagus.
  2. Esophagectomy
  3. Esophagogastrotomy
  4. Esophagoenterostomy

Radio-therapy:

  1. The radiotherapy may be given for a short time to provide relief to pain. Nursing Management:
  2. Please revise the general Nursing Management of the Neoplasm.

PROBLEM SOLVING

PROBLEM SOLVING:

A. DEFINITION OF PROBLEM SOLVING:

A Greek word “problema = throw” or to put forward. Problem solving and decision making are different due to the over-lapping of subject malt and method approach.

  1. METHODS OF PROBLEM SOLVING:
    • Tract & errors
    • Experimentation
    • Problem critical
    • Brain storming
    • Decision
    • Stress
    • Self solving
    • Metaphor biased
    • Technique
  2. STEPS OF PROBLEM SOLVING:
    • Identifying problem
    • Reviewing the data
    • Presenting hypothesis
    • Moving towards a solution
  3. OBSTICLES OF PROBLEM SOLVING:
    • Rigidity
    • Pre-conception
    • Personality characteristics
  4. FACTORS EFFECTING ON PROBLEM SOLVING:
    • Experience
    • Motivation
    • Concept