Adult health Nursing-I Solved past papers- 2019

Q1) Explain Strategies for managing patient with urinary stress incontinence

Ans :- The nurse instructs the patient to:

1)Avoid bladder irritants, such as caffeine, alcohol, and aspartame (NutraSweet).

2)Avoid taking diuretic agents after 4 pm.

3)increased awareness of the amount and timing of all fluid intake.

4)Perform all pelvic floor muscle exercises as prescribed, every day.

5)Stop smoking (smokers usually cough frequently, which increases incontinence).

6)Take steps to avoid constipation: Drink adequate fluids, eat a well-balanced diet high in fiber, exercise regularly, and take stool softeners if recommended.

7)Void regularly, 5–8 times a day (about every 2–3 hours):

  • First thing in the morning
  • Before each meal
  • Before retiring to bed
  • Once during the night if necessary

Q2) a) difference between AIDS and HIV

  1. b) explain the prevention of HIV

HIV:

HIV (Human Immunodeficiency Virus)

HIV is the acronym for human deficiency virus

Virus that invades the immunity system

Patient may suffer minor difficulties; symptoms will be similar to flu

AIDS:

AIDS (acquired immunodeficiency syndrome)

AIDS is the acronym for acquired immune deficiency syndrome

Large stage of spectrum of conditions, initially caused by the infection of (HIV)

Patient will experience severe sign and symptoms, disrupting the quality of life

Prevention of HIV

Individuals can reduce the risk of HIV infection by limiting exposure to risk factors.

1)Male and female condom use before sex

2)Testing and counselling for HIV and STIs

3)Testing and counselling, linkages to tuberculosis (TB) care

4)Avoid sharing contaminated needles, syringes and other injecting equipment and drug solutions when injecting drugs

5)Elimination of mother-to-child transmission of HIV

Q3) enlist types of hypersensitivity and explain management of any one of them And :- Definition

Hypersensitivity is an excessive or aberrant immune response to any type of stimulus

Types of hypersensitivity

1)Anaphylactic (Type I) Hypersensitivity

2)Cytotoxic (Type II) Hypersensitivity

3)Immune Complex (Type III) Hypersensitivity

4)Delayed-Type (Type IV) Hypersensitivity

Anaphylactic (Type I) Hypersensitivity Management

1)​Antihistamines act​to block the effects of ​histamine​, which reduces ​vascular permeability ​and ​bronchoconstriction​.
2)Corticosteroids ​which can be used to reduce the inflammatory response, as well as epinephrine​, which is sometimes given during severe reactions via intramuscular injections through an EpiPen or ​intravenous​injection.
3)​Epinephrine​can help constrict blood vessels and prevent ​anaphylactic shock​.

Q4) enlist complication of chemotherapy

Ans :- ​Complication of chemotherapy

  • Hair loss.
  • Easy bruising and bleeding.
  • Anemia (low red blood cell counts)
  • Nausea and vomiting.
  • Appetite changes.

Q5) explain immediate post operative care of patient after appendectomy Ans :-

Post Operative care

1)Monitor vital sign.
2)Assess level of consciousness.
3)Assess bleeding at wound site.
4)Give clear fluid for first POD.
5)Monitor for infection and any complication at the wound incision.
6)Administer IV prophylaxis antibiotics as ordered.
7)Maintain aseptic technique during dressing.
8)Encourage patient to do ROM exercise.

Q6) English types of abortion and explain management of any one Ans :- Definition

Interruption of pregnancy or expulsion of the product of conception before the fetus is viable is called abortion. The fetus is generally considered to be viable any time after the fifth to sixth month of gestation.

Types of abortion

1)Threatened abortion:-

The term threatened abortion is used when a pregnancy is complicated by vaginal bleeding before the 20th week. Pain may not be a prominent feature of threatened abortion, although a lower abdominal dull ache sometimes accompanies the bleeding. Vaginal examination at this stage usually reveals a closed cervix. 25% to 50% of threatened abortion eventually result in loss of the pregnancy.

Management

The patient is kept at rest in bed until 2 days after blood loss has ceased. Intercourse is forbidden. As soon as the initial bleeding has stopped an ultrasound scan is performed. This will reveal whether or not the pregnancy is intact. The prognosis is good when all abnormal signs and symptoms disappear and when the resumption of the progress of pregnancy is apparent.

2)Inevitable abortion:-

In case of inevitable abortion, a clinical pregnancy is complicated by both vaginal bleeding and cramp-like lower abdominal pain . The cervix is frequently partially dilated, attesting to the inevitability of the process.

Management

The uterus usually expels its contents unaided , and examination must be made with strict aseptic technique. If the abortion is not quickly completed, or if hemorrhage becomes severe, the contents of the uterus are removed with a suction curettege.

3)Incomplete Abortion:-

In addition to vaginal bleeding, cramp-like pain, and cervical dilatation , an incomplete abortion involves the passage of products of conception , often described by the women as looking like pieces of skin or liver.

Management

Patients require admission to the hospital. Treatment is aimed at preventing infection, controlling bleeding and obtaining an empty and involuting uterus. The chief risks associated with retained products are hemorrhage and sepsis.

4)Missed Abortion: –

The term missed abortion is used when the fetus has died but is retained in the uterus, usually for some weeks. After 16 weeks’ gestation, dilatation and curettage may become a problem. Fibrinogen levels should be checked weekly until the fetus and placenta are expelled.

Management

Once the diagnosis has been made the uterus should be emptied. Early in gestation evacuation of the uterus is usually accomplished by suction curettage. The prognosis for the mother is good. Serious complications are uncommon.

5) Recurrent Abortion: –

Recurrent abortion refers to any case in which there have been three consecutive spontaneous abortions. Possible causes are known to be genetic error, anatomic abnormalities of the genital tract, hormonal abnormalities, infection, immunologic factors, or systemic disease.

Management

Paternal and maternal chromosomes should be evaluated. The mother should be ruled out the presence of systemic disorders such as DM, SLE, and thyroid disease. It should rule out the presence of Mycoplasma, Listeria, Toxoplasma etc. infectious disease. Pelvic examination

Q7) English types of abortion and explain management of them

Types of abortion
1)Threatened abortion
2)Inevitable abortion
3)Incomplete Abortion
4)Missed Abortion
5)Recurrent Abortion

 

 

Adult health Nursing-I Solved past paper -2018

Q1) a) define Folic acid deficiency anemia.

Folate-deficiency anemia is a decrease in red blood cells (anemia) due to a lack of folate. Folate is a type of vitamin B. It is also called folic acid. Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.

b) write down the dietary sources of Folic acid

  1. Legumes (beans, peas, lentils)
  2. Asparagus
  3. Eggs
  4. Leafy greens
  5. Beets
  6. Citrus fruits
  7. Brussels sprouts
  8. Broccoli
  9. Nuts and seeds
  10. Beef liver
  11. Wheat germ
  12. Papaya
  13. Bananas
  14. Avocado
  15. Fortified grains

c) write down the importance of Folic acid in human body

1)Folic acid helps your body produce and maintain new cells.

2)It helps prevent changes to DNA that may lead to cancer.

3)As a medication, folic acid is used to treat folic acid deficiency and certain types of anemia (lack of red blood cells) caused by folic acid deficiency.

Q2) a) define appendicitis

It is an acute inflammation of vermiform appendix (a small finger like appendage attached to caecum just below the ileocecal valve)

  1. write down the sign and symptoms of appendicitis
  • progressively worsening pain
  • painful coughing or sneezing
  • nausea
  • vomiting
  • diarrhea
  • inability to pass gas (break wind)
  • fever
  • constipation
  • loss of appetite
  1. write down the nursing management of appendicitis
    1. Maintain NPO status.
    2. Administer fluids intravenously to prevent dehydration.
    3. Monitor for changes in level of pain.
    4. Monitor for signs of ruptured appendix and peritonitis.
    5. Position right-side lying or low to semi fowler position to promote comfort.
    6. Monitor bowel sounds.

Q3) define ovarian cyst

Ovarian cysts are fluid-filled sacs or pockets in an ovary or on its surface. Women have two ovaries, each about the size and shape of an almond on each side of the uterus.

  1. write down the causes and management of ovarian cyst
    1. Hormonal problems. Functional cysts usually go away on their own without treatment.
    2. Women with endometriosis can develop a type of ovarian cyst called an endometrioma.
    3. Severe pelvic infections.

Management

▪ Functional/physiologic cysts usually resolve spontaneously

MEDICATIONS

  • Uncomplicated cyst rupture (hemodynamically stable) ▫Pain management (e.g., NSAIDs)

SURGERY

Laparoscopy/laparotomy

  • Ongoing hemorrhage, hemodynamic instability, torsion/rupture risk
  • Ovarian cystectomy ▫Removal of abnormal tissue only
  • Unilateral/bilateral oophorectomy ▫Removal of entire ovary(ies); recommended for menopausal/ postmenopausal individuals, if malignancy confirmed

Q4) define polycythemia

Polycythemia refers to an increase in the number of red blood cells in the body. The extra cells cause the blood to be thicker, and this, in turn, increases the risk of other health issues, such as blood clots.

  1. discuss types of polycythemia
    1. PRIMARY POLYCYTHEMIA

Primary Polycythemia occurs when excess red blood cells are produced as a result of an abnormality of the bone marrow. Often, excess white blood cells and platelets are also produced.

  1. SECONDARY POLYCYTHEMIA

Secondary polycythemia is usually due to increased erythropoietin (EPO) production either in response to chronic hypoxia (low blood oxygen level) or from an erythropoietin secreting tumor.

  1. RELATIVE POLYCYTHEMIA

Relative erythrocytosis is an increase in RBC numbers without an increase in total RBC mass. Usually, this is caused by loss of plasma volume with resultant hemo-concentration, as seen in severe dehydration related to vomiting and diarrhea.

  1. STRESS POLYCYTHEMIA

Stress polycythemia is a term applied to a chronic (long standing) state of low plasma volume, which is seen commonly in active, hardworking, anxious, middle-aged men. In these people, the red blood cell volume is normal, but the plasma volume is low.

  1. write down the nursing intervention of polycythemia
    1. Monitor for peripheral and cerebral thrombosis.
    2. Assist the patient for ambulation
    3. Perform phlebotomy as per doctor’s order
  2. Administer iv fluids and encourage to take oral fluids
  3. Administer pain management measures
  4. Advice to do regular exercise
  5. Instruct to avoid tobacco
  6. Advise to maintain skin hygiene
  7. Avoid extreme temperatures
  8. Provide psychological support to the patient.

Q5) a) define infertility

Inability to achieve pregnancy with limited intercourse for at least 1 year

  1. write down the causes of infertility in male and female Causes of infertility in females

1)​The most common overall cause of female infertility is the failure to ovulate.

2)Problems with the menstrual cycle, the process that prepares the female body for pregnancy, can lead to infertility.

3)Structural problems usually involve the presence of abnormal tissue in the fallopian tubes or uterus.

4)Infections can also cause infertility in men and women.

5)Implantation failure refers to the failure of a fertilized egg to implant in the uterine wall to begin pregnancy.

6)Polycystic Ovary Syndrome (PCOS) is one of the most common causes of female infertility.

7)Primary Ovary Insufficiency (POI) is a condition in which a woman’s ovaries stop producing hormones and eggs at a young age.

8)​Autoimmune disorders cause the body’s immune system to attack normal body tissues it would normally ignore. Autoimmune disorders, such as lupus, Hashimoto’s and other types of thyroiditis, or rheumatoid arthritis, may affect fertility.

Causes of infertility in Males

1)​Sperm Disorders

The most common problems are with making and growing sperm. Sperm may:

  • not grow fully
  • be oddly shaped
  • not move the right way
  • be made in very low numbers (oligospermia)
  • not be made at all (azoospermia)

2)​Varicoceles

Varicoceles are swollen veins in the scrotum. ​They harm sperm growth by blocking proper blood drainage.

3)​Retrograde Ejaculation

Retrograde ejaculation is when semen goes backwards in the body. They go into your bladder instead of out the penis. This happens when nerves and muscles in your bladder don’t close during orgasm (climax). Semen may have normal sperm, but the semen cannot reach the vagina.

4)​Immunologic Infertility

Sometimes a man’s body makes antibodies that attack his own sperm.

5)​Obstruction

Sometimes sperm can be blocked. Repeated infections, surgery (such as vasectomy), swelling or developmental defects can cause blockage. Any part of the male reproductive tract can be blocked. With a blockage, sperm from the testicles can’t leave the body during ejaculation.

6)Hormones

Hormones made by the pituitary gland tell the testicles to make sperm. Very low hormone levels cause poor sperm growth.

7)Chromosomes

Sperm carries half of the DNA to the egg. Changes in the number and structure of chromosomes can affect fertility. For example, the male Y chromosome may be missing parts.

8)Medication

Certain medications can change sperm production, function and delivery. These medications are most often given to treat health problems like:

  • arthritis
  • depression
  • digestive problems
  • infections
  • high blood pressure
  • cancer

Q6) a) define peritonitis

Inflammation of the peritoneum (The peritoneum is the tissue layer of cells lining the inner wall of the abdomen and pelvis). Peritonitis can result from infection (such as bacteria or parasites), injury and bleeding, or diseases (such as systemic lupus erythematosus).

  1. discuss the causes of peritonitis
    1. a burst stomach ulcer.
    2. a burst appendix.
    3. digestive problems, such as Crohn’s disease or diverticuliti
    4. injury to the stomach.
    5. pelvic inflammatory disease
  1. write down the nursing management of peritonitis
    1. Blood pressure monitoring. The patient’s blood pressure is monitored by arterial line if shock is present
    2. Administration of analgesic and anti-emetics can be done as prescribed.
    3. Pain management. Analgesics and ​positioning​could help in decreasing pain.
      I&O monitoring.
    4. Accurate recording of all ​intakes and output​could help in the assessment of fluid replacement.
    5. IV fluids​. The ​nurse​administers and closely monitors IV fluids.
    6. Drainage monitoring. The nurse must monitor and record the character of the drainage postoperatively.

Q7) write the short note on the following

1)CT scan

A computerized tomography (CT) scan combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels and soft tissues inside your body. CT scan images provide more-detailed information than plain X-rays do.

2) upper and lower endoscopies

Endoscopy is a procedure in which the gastrointestinal (GI) tract is viewed through a fiber-optic camera known as an endoscope, inserted either through the mouth (upper) to scan the esophagus, stomach and small intestines, or through the anus (lower) to examine the large intestine, colon and rectum.

3) parenthesis

Parenthesis​refer to punctuation marks “(” and “)” used to separate relevant information or a comment from the rest of the text, or to enclose mathematical symbols, or the text inside of these marks. The punctuation marks in the math equation 2x (4+6) are an example ​of ​parenthesis​.

4) cystoscopy

Cystoscopy (sis-TOS-kuh-pee) is a procedure that allows your doctor to examine the lining of your bladder and the tube that carries urine out of your body (urethra). A hollow tube (cystoscope) equipped with a lens is inserted into your urethra and slowly advances into your bladder.

5) metabolic acidosis

Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body’s acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids.

The most common causes of hyperchloremic metabolic acidosis are gastrointestinal bicarbonate loss, renal tubular acidosis, drugs-induced hyperkalemia, early renal failure, and administration of acids.

 

Adult Health Nursing-I solved past paper- 2019

Q1) a) describe cirrhosis of liver

Cirrhosis of the liver is a chronic, progressive disease characterized by widespread fibrosis(scarring) and nodule formation.

The development of cirrhosis is an insidious, prolonged course, usually after decades of chronic liver disease.

b) enlist its signs and symptoms

Some of the more common symptoms and signs of cirrhosis include:

    1. Yellowing of the skin (jaundice) due to the accumulation of bilirubin in the blood
    2. Fatigue
    3. Weakness
    4. Loss of appetite
    5. Itching
    6. Easy bruising from decreased production of blood clotting factors by the diseased liver.
  1. list 10 points of nursing intervention
    1. Promoting rest ​to conserve energy
    2. Improving nutritional status
    3. Providing skin care
    4. Reducing risk of injury
    5. Monitoring & managing Potential complication
  • Bleeding & hemorrhage
  • Hepatic encephalopathy
  • Fluid Volume excess
  1. Promoting home & self care
  2. Client teaching like deep breathing techniques.
  3. Provide adequate nutrition and education, encourage lifestyle changes
  4. Provide a quiet and calm environment.
  5. Provide comfort measures such as back rubbing and changing position to relieve pain.

Q2) a) define intestinal obstruction and its types

This obstruction can involve only the small intestine (small bowel obstruction), the large intestine (large bowel obstruction), or via systemic alterations, involving both the small and large intestine (generalized ileus). The “obstruction” can involve a mechanical obstruction or, in contrast, may be related to ineffective motility without any physical obstruction, so-called functional obstruction, “pseudo-obstruction,” or paralytic ileus

There are two main types

  1. Mechanical
    1. It is caused by physical barrier
      1. Adhesions
        1. Cause Tissue and organ stick together
      2. Tumor
      3. Hernia
      4. Intussusception
      5. Volvulus
      6. Fecal impaction
  2. Functional
    1. Lack or absence of peristalsis
      1. Lack of muscular contractions to move food contents

b) describe its management and nursing care

1)Collaborative Care

a. Relieving pressure and obstruction

b. Supportive care

2)Gastrointestinal Decompression

a. Treatment with nasogastric or long intestinal tube provides bowel rest and removal of air and fluid

b. Successfully relieves many partial small bowel obstructions

3)Surgery

a. Treatment for complete mechanical obstructions, strangulated or incarcerated obstructions of small bowel, persistent incomplete mechanical obstructions

b. Preoperative care

1.Insertion of nasogastric tube to relieve vomiting, abdominal distention, and to prevent aspiration of intestinal contents

2.Restore fluid and electrolyte balance; correct acid and alkaline imbalances

3.Laparotomy: inspection of intestine and removal of infarcted or gangrenous tissue

4.Removal of cause of obstruction: adhesions, tumours, foreign bodies, gangrenous portion of intestines and anastomosis or creation of colostomy depending on individual case

4)Nursing Care

a. Prevention includes healthy diet, uid intake

b. Exercise, especially in clients with recurrent small bowel obstructions

Q3) a) define renal failure and its causes

Definition

A condition in which the ​kidneys​stop working and are not able to remove waste and extra water from the blood or keep body chemicals in balance. Acute or severe renal failure​happens suddenly (for example, after an injury) and may be treated and cured.

The most common causes are:

    1. high blood pressure
    2. chronic glomerulonephritis (kidney damage)
    3. high blood sugar (diabetes)
    4. polycystic kidney disease
    5. blocked urinary tract
    6. kidney infection
  1. describe acute renal failure along with nursing care

Acute kidney failure​happens when your ​kidneys​suddenly lose the ability to eliminate excess salts, fluids, and waste materials from the blood. This elimination is the core of your ​kidneys​’main function. Body fluids can rise to dangerous levels when ​kidneys lose their filtering ability.

Nursing Interventions:

  1. Monitor 24-hour urine volume to follow clinical course of the disease.
  2. Monitor BUN, creatinine, and electrolyte.
  3. Monitor ABG levels as necessary to evaluate acid-base balance.
  4. Weigh the patient to provide an index of fluid balance.
  5. Measure blood pressure at various times during the day with patients in supine, sitting, and standing positions.
  6. Adjust fluid intake to avoid volume overload and dehydration.
  7. Watch for cardiac dysrhythmias and heart failure from hyperkalaemia, electrolyte imbalance, or fluid overload. Have resuscitation equipment available in case of cardiac arrest.
  8. Watch for urinary tract infection and remove bladder catheter as soon as possible.
  9. Employ intensive pulmonary hygiene because incidence of pulmonary oedema and infection is high.

10.Provide meticulous wound care.

11.Offer high-carbohydrate feedings because carbohydrates have a greater protein-sparing power and provide additional calories.

12.Institute seizure precautions. Provide padded side rails and have airway and suction equipment at the bedside.

13.Encourage and assist the patient to turn and move because drowsiness and lethargy may reduce activity.

14.Explain that the patient may experience residual defects in kidney function for a long time after acute illness.

15.Encourage the patient to report routine urinalysis and follow-up examinations.

16.Recommend resuming activity gradually because muscle weakness will be present from excessive catabolism.

Q4) a) what is abortion and describe its causes and types

Abortion is the termination of pregnancy before viability of the featus before 22 weeks or if the fetal weight is less than 500gm.

Or

Interruption of pregnancy or expulsion of the product of conception before the fetus is viable is called abortion. The fetus is generally considered to be viable any time after the fifth to sixth month of gestation.

There are three main types

    1. Spontaneous Abortion
      1. It is caused by
        1. abnormality in the fetus
        2. systemic diseases
        3. hormonal imbalance
        4. anatomic abnormalities
    2. Habitual Abortion
      1. It is caused by
        1. chromosomal anomalies
    3. Induced Abortion
      1. It is caused by
        1. A voluntary induced termination of pregnancy is performed by skilled health care providers
  1. right management of habitual abortion

Medical Management

After a spontaneous abortion, all tissue passed vaginally is saved for examination, if possible. The patient and all personnel who care for her are alerted to save any discharged material. In the rare case of heavy bleeding,the patient may require blood component transfusions and fluid replacement. An estimate of the bleeding volume can be determined by recording the number of perineal pads and the degree of saturation over 24 hours. When an incomplete abortion occurs, oxytocin may be prescribed to cause uterine contractions before D&E or uterine suctioning.

Nursing management

Because patients experience loss and anxiety, emotional support and understanding are important aspects of nursing care. Women may be grieving or relieved, depending on their feelings about the pregnancy. Providing opportunities for the patient to talk and express her emotions is helpful and also provides clues for the nurse in planning more specific care.

Q5) a) what is your understanding about infertility

Infertility is defined as a couple’s inability to achieve pregnancy after 1 year of unprotected intercourse

b) describe its pathophysiology and its management

Pathophysiology

  1. Age
  2. Weight
  3. Genetic causes ; turner syndrome
  4. Hypothalamic pituitary disorder
  5. Anatomical disorders

Management

  1. Assist in reducing stress in relationship
  2. Encourage cooperation
  3. Protect privacy
  4. Foster understanding and refer the couple to appropriate resources when necessary . Because infertility workups are expensive, time consuming , invasive , stressful, and not always successful .
  5. Couples need support in working together to deal with endeavor
  6. Smoking is strongly discouraged because it has an adverse effect on the success of assisted reproduction
  7. Diet, exercise , stress reduction techniques, health maintenance ,and disease prevention are being emphasized in many infertility programs .

Q6) a) define anaemia

Anaemia​is a condition in which you lack enough healthy red blood cells to carry adequate oxygen to your body’s tissues. Having ​anaemia​can make you feel tired and weak. There are many forms of ​anaemia​, each with its own cause.

b) enlist its types

The seven types of anaemia

  1. Iron deficiency anaemia​.
  2. Thalassaemia.
    1. Aplastic ​anaemia​.
    2. Haemolytic ​anaemia​.
    3. Sickle cell ​anaemia​.
    4. Pernicious ​anaemia​.
    5. Fanconi ​anaemia​.
  3. describe iron deficiency anemia in detail

As the name implies, ​iron deficiency anemia​is due to insufficient ​iron​. Without enough ​iron​, your body can’t produce enough of a substance in red blood cells that enables them to carry oxygen (hemoglobin). As a result, ​iron deficiency anemia​may leave you tired and short of breath.

Iron-Deficiency Anemia: Signs, Symptoms, and Treatment

  • Fatigue.
  • Weakness.
  • Pale skin.
  • Shortness of breath.
  • Dizziness.
  • Swollen, sore tongue.
  • Abnormal heart rate.

To treat iron deficiency anemia, your doctor may recommend that you take ​iron supplements​.

Iron supplements

  • Take ​iron​tablets on an empty stomach.
  • Don’t take ​iron​with antacids.
  • Take ​iron​tablets with vitamin C.

Q7) differentiate between palliative care and hospice care

Hospice care Palliative care
1) It is mainly based on comfortable care without any intention of curing a patient It targets on patient comfort and care with or without the presence of curative
2) Requires physician certification Does not require physician certification
3) Patient is not seeking curative measures or return to the hospital Patient may be seeking curative measures or return to the hospital
4) Patient has a terminal or untreatable illness with fewer than 6 months to live in the normal course of the disease Patient has a serious chronic or life limiting illness
5) Focus on symptoms management and quality of life Address goals of care focus on symptoms management and quality of life
6) Usually takes place in a home or home like environment Usually takes place in a hospital or medical facility
7) Patient has agreed to stop active/curative treatment Can be provided with active/curative treatment

 

Adult Health Nursing-I Solved past paper 2016-LUMHS

Q1) define first line defence /immune system

The ​first line​of ​defence​is your innate ​immune system​. Level one of this ​system consists of physical barriers like your skin and the mucosal lining in your respiratory tract. The tears, sweat, saliva and mucous produced by the skin and mucosal lining are part of that physical barrier.

The bodys first line of defense against pathogens uses mostly physical and chemical barriers such as

  1. Skin ​– acts as a barrier to invasion
  2. Sweat​– has chemicals which can kill different pathogens.
  3. Tears​- have lysozyme which has powerful digestive abilities that render antigens harmless.

Q2) define infertility and requirement for conception

In general, ​infertility​is ​defined​as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex.

The necessary requirements for conception to occur are the following:

  • The fallopian tubes must be unobstructed and functional to receive the egg from the ovary and allow it to meet with the sperm.
  • The sperm must have normal parameters of concentration, forward motility and viability to be able to reach the egg overcoming all the natural hurdles they meet in the way.
  • The passing of the sperm from the vagina to the fallopian tubes must be smooth with a friendly environment from the cervical mucus.ed from the follicle.
  • Ovulation must occur so that a mature egg is release
  • Sexual intercourse must take place during the fertile days.

Q3) describe types of metabolic acidosis

Metabolic acidosis​is a serious electrolyte disorder characterized by an imbalance in the body’s acid-base balance. ​Metabolic acidosis​has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidneys to excrete excess acids.

Metabolic acidosis is classified into two types: Metabolic acidosis is classified into two types:

(a)metabolic acidosis with normal AG​ (with increased Cl ¯ ) and (a)metabolic acidosis with normal AG ( with increased Cl ¯ ) and (b) metabolic acidosis with high AG (with normal Cl ¯).

  1. metabolic acidosis with high AG​ (with normal Cl ¯). An increased AG means the accumulation of non-volatile acids in the body. An increased AG means the accumulation of non-volatile acids in the body.

Q4) define abortion and types of abortion

Definition

Interruption of pregnancy or expulsion of the product of conception before the fetus is viable is called abortion. The fetus is generally considered to be viable any time after the fifth to sixth month of gestation.

Types of abortion

1)Threatened abortion:-

The term threatened abortion is used when a pregnancy is complicated by vaginal bleeding before the 20th week. Pain may not be a prominent feature of threatened abortion, although a lower abdominal dull ache sometimes accompanies the bleeding. Vaginal examination at this stage usually reveals a closed cervix. 25% to 50% of threatened abortion eventually result in loss of the pregnancy.

Management

The patient is kept at rest in bed until 2 days after blood loss has ceased. Intercourse is forbidden. As soon as the initial bleeding has stopped an ultrasound scan is performed. This will reveal whether or not the pregnancy is intact. The prognosis is good when all

abnormal signs and symptoms disappear and when the resumption of the progress of pregnancy is apparent.

2)Inevitable abortion:-

In case of inevitable abortion, a clinical pregnancy is complicated by both vaginal bleeding and cramp-like lower abdominal pain . The cervix is frequently partially dilated, attesting to the inevitability of the process.

Management

The uterus usually expels its contents unaided , and examination must be made with strict aseptic technique. If the abortion is not quickly completed, or if hemorrhage becomes severe, the contents of the uterus are removed with a suction curettege.

3)Incomplete Abortion:-

In addition to vaginal bleeding, cramp-like pain, and cervical dilatation , an incomplete abortion involves the passage of products of conception , often described by the women as looking like pieces of skin or liver.

Management

Patients require admission to the hospital. Treatment is aimed at preventing infection, controlling bleeding and obtaining an empty and involuting uterus. The chief risks associated with retained products are hemorrhage and sepsis .

4)Missed Abortion:-

The term missed abortion is used when the fetus has died but is retained in the uterus, usually for some weeks. After 16 weeks ’ gestation, dilatation and curettage may become a problem. Fibrinogen levels should be checked weekly until the fetus and placenta are expelled.

Management

Once the diagnosis has been made the uterus should be emptied. Early in gestation evacuation of the uterus is usually accomplished by suction curettage. The prognosis for the mother is good. Serious complications are uncommon .

5)Recurrent Abortion:-

Recurrent abortion refers to any case in which there have been three consecutive spontaneous abortions. Possible causes are known to be genetic error, anatomic

abnormalities of the genital tract, hormonal abnormalities, infection, immunologic factors, or systemic disease .

Management

Paternal and maternal chromosomes should be evaluated. The mother should be ruled out the presence of systemic disorders such as DM,SLE, and thyroid disease. It should rule out the presence of Mycoplasma, Listeria, Toxoplasma etc. infectious disease.Pelvic examination

Q5) define nursing intervention for patient with acute pancreatitis

Nursing Interventions

  1. relieving pain and discomfort
  2. restoring adequate fluid balance
  3. improving breathing pattern
  4. improving nutritional status
  5. improving skin integrity
  6. monitoring and managing potential complications
  7. Change in position
  8. Monitor pulse oximetry

Q6) describe stomatitis and its nursing management

Stomatitis Definition ​: Stomatitis is an inflammation of the mucous lining of the mouth , which may involve the cheeks, gums ,tongue ,lips , and roof or floor of the mouth. The word“ stomatitis “ literally means inflammation of the mouth.

Nursing Management

  1. Instruct the client to brush and floss his teeth and massage his gums several times daily.
  2. Advise the client to use gauze or a sponge toothette to clean the oral mucosa when pain prevents the use of a toothbrush.
  3. Recommend the use of water, saline, or a dilute solution of hydrogen peroxide instead of toothpaste or mouthwash.
  4. Advise the client to eat a bland diet.
  5. Suggest that the client consume lukewarm, or cold food and fluids, which may minimize discomfort and result in increased intake.

Q7) define Hernia and types of hernia

Define Hernia

A condition in which part of an organ is displaced and protrudes through the wall of the cavity containing it (often involving the intestine at a weak point in the abdominal wall)

Types of hernia

1.) Inguinal hernia

i.) Indirect inguinal hernia

ii.) Direct inguinal hernia (in contrast)

2.) Hiatal Hernia

3.) Femoral hernias (protrude through the femoral ring)

4.) Umbilical hernia (congenital/acquire)

5.) Incisional/ventral hernias (occur at the site of previous surgical incision)

 

 

 

Hypertension

Key facts

  • Hypertension, or high blood pressure, is a life-threatening medical condition that greatly raises the chances of cardiovascular disease, stroke, dementia, and renal failure, and many others.
  • It is estimated that 1.28 billion individuals aged 30-79 years worldwide have hypertension, with the majority (two-thirds) living in low- and middle-income countries.
  • Additionally, it is estimated that 46 percent of adults with hypertension do not know they have the illness.
  • Hypertension is detected in less than half of adult patients (42%).
  • Only about a fifth of persons with hypertension (21%) have it under control.
  • Premature mortality due to hypertension is a serious global health problem.

What exactly is hypertension?

Blood pressure is the force produced by flowing blood on the arterial walls, the body’s primary blood vessels. Hypertension is too high blood pressure.

Blood pressure is expressed as a pair of numbers. The first number (systolic) shows the blood vessel pressure when the heart contracts or beats. The second number (diastolic) indicates the pressure in the blood arteries between heartbeats.

When tested on two separate days, hypertension is diagnosed if the systolic blood pressure readings on both days are 140 mmHg and/or the diastolic blood pressure readings on both days are 90 mmHg.

Know the Risk Factors for High Blood Pressure (Hypertension) | Top 10 Home  RemediesWhat risk factors are associated with hypertension?

Unhealthy diets (excessive salt consumption, a diet heavy in saturated fat and trans fats, and a poor intake of fruits and vegetables), physical inactivity, cigarette and alcohol use, and being overweight or obese are modifiable risk factors.

Non-modifiable risk factors include a family history of hypertension, age over 65, and coexisting conditions like diabetes or renal illness.

Pathophysiology Of Primary Hypertension

Hypertension is characterised by a consistently elevated SVR.

Retention of water and sodium: A high sodium intake may activate many pressor systems and produce water retention.

High plasma renin activity (PRA) causes an increase in the conversion of angiotensinogen to angiotensin I, which causes arteriolar constriction, vascular hypertrophy, and aldosterone production.

Stress and increased SNS activity: Anger, fear, and pain have an effect on arterial pressure. Normally protective physiological reactions to stress may continue to a pathologic degree, resulting in a protracted increase in SNS activity. Enhanced SNS activation results in increased vasoconstriction, heart rate, and renin release.

Insulin resistance and hyperinsulinemia are frequent in primary hypertension, as are abnormalities of glucose, insulin, and lipoprotein metabolism. Vascular hypertrophy and enhanced renal salt reabsorption are supplementary pressor effects of insulin.

Endothelial cell dysfunction is characterised by a diminished vasodilator response to nitric oxide in some hypertensive individuals. Nitric oxide, an endothelium-derived relaxing factor (EDRF), helps maintain low arterial tone at rest, inhibits smooth muscle layer development, and prevents platelet aggregation. Vasoconstriction produced by endothelin is pronounced and protracted.

Symptoms of low blood pressure include feeling tired or dizzy.What are common hypertension symptoms?

Hypertension is referred to as the “silent killer.” The majority of hypertensive individuals are unaware of their condition, since there may be no warning indications or symptoms. Therefore, it is crucial that blood pressure be monitored often.

When symptoms do manifest, they might include headaches in the early morning, nosebleeds, abnormal heart rhythms, visual problems, and a buzzing sound in the ears. Severe hypertension may result in tiredness, nausea, vomiting, disorientation, anxiety, chest discomfort, and tremors.

A professional measurement of blood pressure is the sole method for detecting hypertension. The measurement of blood pressure is rapid and painless. Individuals may test their own blood pressure using automated equipment, but a professional examination is necessary for assessing risk and related problems.

What are the complications of hypertension that is uncontrolled?

In addition to other issues, hypertension may cause severe heart damage. Excessive pressure may cause artery hardening, reducing blood and oxygen flow to the heart. This increased blood pressure and decreased blood flow may result in:

  • Chest discomfort, often known as angina.
  • Heart attack, which happens when the heart’s blood flow is obstructed and heart muscle cells are deprived of oxygen, is fatal. The longer the heart is deprived of blood flow, the worse the cardiac damage.
  • Heart failure occurs when the heart is unable to pump sufficient blood and oxygen to other critical organs.

The irregular heartbeat that might cause abrupt death.

Additionally, hypertension may rupture or obstruct the arteries that feed blood and oxygen to the brain, resulting in a stroke.

Additionally, hypertension may damage the kidneys, leading to renal failure.

Why is hypertension a significant problem in low- and middle-income nations?

The prevalence of hypertension varies by geography and socioeconomic level within a nation. The WHO African Region has the greatest prevalence of hypertension at 27%, whilst the WHO American Region has the lowest incidence at 18%.

From 1975 to 2015, the number of individuals with hypertension grew from 594 million to 1.13 billion, with the majority of the rise occurring in low- and middle-income nations. This increase is mostly attributable to an increase in hypertension risk factors in these groups.

How may the consequences of hypertension be reduced?

Reducing hypertension avoids heart attacks, strokes, and renal damage, among other health complications.

Prevention

  • reducing salt consumption (to less than 5g daily).
  • Increasing consumption of fruits and vegetables.
  • Physical activity on a regular basis.
  • avoiding tobacco usage.
  • reducing the amount of alcohol consumed.
  • Restricting consumption of foods rich in saturated fats.
  • Dietary elimination or reduction of trans fats.

Management

  • Stress reduction and management.
  • Routinely monitoring blood pressure.
  • The treatment of high blood pressure
  • Managing additional health issues.

Nursing Management

Primary nursing duties for the long-term management of hypertension include assisting the patient in lowering blood pressure and adhering to the treatment plan. The nursing interventions include patient and family education, detection and reporting of adverse treatment effects, assessment and improvement of compliance, and evaluation of therapeutic efficacy.

Patient and family-centered instruction involves the following:

(1) dietary treatment,

(2) pharmacological therapy,

(3) physical exercise,

(4) home monitoring of blood pressure (if appropriate), and

(5) cessation of cigarette use (if applicable).

Adult Health Nursing MCQs

1) It is clinical condition in which the arterial PH is greater then 7.45 PaCO3 is less then 38 mmHg.
A. Respiratory distress
B. Alkalosis & Acidosis
C. Respiratory acidosis
D. Respiratory alkalosis

2) Which nursing diagnosis is most applicable to client with fecal incontinences?
A. Risk for deficient fluid volume
B. Disturbed body image
C. Bowel incontinence
D. Altered nutrition: more than body requirement

3) Cystitis is a type of urinary tract infection of:
A. Uncomplicated lower or upper UTI
B. Upper UTI
C. Complicated lower or upper UTI
D. Lower UTI

4) When counseling a client in ways to prevent cholecystitis, which of the following guidelines is most important?
A. Eat a low-fat low cholesterol diet
B. Limit exercise to 10 minutes/day
C. Keep weight proportionate to height
D. Eat a low-protein diet

5) % of abortion in the first 12 weeks of pregnancy result from chromosomal abnormalities:
A. 50 to 80
B. 20 to 30
C. 30 to 40
D. 40 to 45

6) The patient should be setting when deep breating and coughing because this position:
A. Loosens respiratory secretions
B. Helps the patient to support their incision wiht a pillow
C. Allows the patient to observe their area and relex
D. Is physically more comfortable for the patient

7) Five minutes after the client’s first post operative exercise, the client’s vital sign have not yet return to baseline. Which is an appropriate nursing diagnosis:
A. Alteration in comfort
B. Risk for activity intolerance
C. Impaired physical mobility
D. Risk for discuss syndrome
8) The doctor has ordered 500 mg of a medication po once a day. The tablets on hand are labeled as 1 tablet = 250 mg. How many tablets will you administer to your patient?
A. 03 Tablets
B. 1 Tablets
C. 02 Tablets
D. 04 Tablets

9) Foods high in purine are restricted to patients in:
A. Calcium stones
B. Oxalate stones
C. Uric acid stones
D. Struvite stones

10) What is/are the most common cause(s) of chronic liver disease?
A. Obesity
B. Bacteria
C. Gall bladder stones
D. Alcohol abuse

11) Inflammation of the lower end of the esophagus leading to a back flow of gastric juices is called:
A. Structural abnormalities
B. Lactose intolerance
C. Acid reflux
D. Reflux esophagitis

12) Which statement about appendicitis is accurate and true?
A. Mc Burney’s point tenderness is suggestive of appendicitis
B. Lefty lower quadrant pain is suggestive of a appendicitis
C. Appendicitis is more common among females than males
D. A high fiber diet is a risk factor associated with appendicitis

13) Renal cell carcinoma which is greater than 7 cm tumor limited to the kidney, no evidence of lymph node involvement & metastatic disease is called:
A. Stage II RCC
B. Stage I RCC
C. Stage IV RCC
D. Stage III RCC

14) Excessive bleeding occurs at frequent intervals in reproductive disorders is:
A. Menometrorrhagia
B. Menorrhagia
C. Polymenorrhea
D. Metrorrhagia

15) A hernia is the of an organ or tissue out of the body cavity in which it is normally found:
A. Trauma
B. Syndrome
C. Protrusion
D. Pressure

16) Swelling of the salivary glands in mumps is called:
A. Periodontitis
B. Parotitis
C. Granuloma

D. Salivitis

17) Painless enlargement of one or more lymph nodes on one side of the neck is:
A. Tuberculosis
B. Non Hodgkin disease
C. Lymphomas
D. Hodgkin’s Disease

18) When establishing realistic goal, the nurse:
A. Bases of the goals on the narse’s personal knowledge
B. Must have the client cooperation
C. Knows the resourses of the health care facility, family and the client
D. Must have a client who is phyiscally and emotionally stable

19) Puberty age in female is:
A. 18 to 19 years
B. 19 to 20 years
C. 16 to 17 years
D. 10 to 14 years

20) A client being treated for chronic cholecystitis should be given which of the following instructions?
A. Use anti cholinergic as prescribed
B. Increase protein in diet
C. Avoid antacids
D. Increase rest

21) Which nursing diagnosis is most applicable to client with fecal incontinence?
A. Altered Nutrition:more than body requirement
B. Risk for Deficient fluid volume
C. Bowel Incontinence
D. Disturbed body image

22) What can reduce a patient’s anxiety and postsurgical pain?
A. Preoperative checklist
B. Psychological counseling
C. Preoperative teaching
D. Preoperative medication
23) A hiatus hernia occurs when the upper part of the stomach is dislocated through the hole, called a Hiatus, in the , into the chest:
A. Duodenum
B. Abdominal cavity
C. Diaphragm
D. Esophagus

24) Mechanical obstruction of intestine in which bowel twists and turns on itself:
A. Adhesions
B. Amyloidosis
C. Volvulus
D. Stenosis

25) Which electrolyte is essential for enyzme and neurological activities?
A. Magnesium
B. Phosphate
C. Potassium
D. Chloride

26) Which of the following stage the carcinogen is irreversible?
A. Progression stage
B. Promotion stage
C. Initiation
D. Regression

27) From the following nursing diagnosis which is suitable for hemorrhoids:
A. Urinary retention related to postoperative reflux spasm and fear of pain
B. Imbalance nutrition less than body requirement
C. Anxity related to surgical intervention
D. Constipation related to ignoring the urge to defecate because of pain during elimination

28) Which one is the best investigation to find out the stone in urinary tract:
A. Ultrasound
B. M.R.I
C. I.V.P
D. CT scan

29) Which is the most common complication of peptic ulcer disease?
A. Haemorrhage
B. Penetration
C. Gastric outlet obstruction
D. Perforation

30) In what order should one perform an abdominal assessment:
A. Inspection, percussion, palpitation, auscultation
B. Inspection, auscultation, percussion, palpitation
C. Percussion, Palpitation, Inspection, Auscultation
D. Palpitation, Inspection, Percussion,. auscultation

31) From the following in which operation patient needs sitz bath:
A. Appendectomy
B. Colostomy
C. Hysterectomy
D. Hemorrhoids

32) Food poisoning “should be suspected with persons who shared food within the previous 1-6 hours, and symptoms of nausea, vomiting,and idarrhea, typically, this is due to:
A. Emetics
B. Infection
C. Intoxication
D. Inebrition

33) Is a malignant disorder of hemopoietic tissues, associated increased number of
leukocytosis in the blood:
A. Hemophilia
B. H. Influenza
C. Leukemia
D. Poly cythemia

34) is primarily a disease of children older than 2 years of age:
A. Acute glomerulonephritis
B. Nephrotic syndrome
C. Renal abscess
D. Acute pyelonephritis

35) Spread of cancer cells from the primary tumor to distant sites:
A. Dysplasia
B. Metaplasia
C. Malignant
D. Metastasis

36) What intervention is the best relieve constipation during pregnancy?
A. Lying flat on back when sleeping
B. Taking a mild over-the counter laxative
C. Reduction of iron intake by half or more
D. Increasing the consumption of fruits and vegetable

37) Anemia which can be classified based on the body temperature and antibodies react with the RBC antigen is:
A. Polycythemia
B. Aplastic anemia
C. Immune hemolytic anemia
D. Hemolytic anemia
38) is disorder in which bone lose density and become porous and fragile:
A. Menarche
B. Osteoporoses
C. Formix
D. Dysmenoria

39) The most appropriate tool in confirmation of malignancy in the patient is:
A. History
B. Physical examination
C. Blood CP
D. Biopsy of tissue

40) Normal Glomerular filtration rate (GFR) per minute is:
A. 115 ml
B. 100 ml
C. 105 ml
D. 120 ml

Adult health Nursing-I solved past paper -2015

Q1) a) define Folic acid deficiency anaemia

Folate​-​deficiency anaemia​is the lack of ​folic acid​in the blood. ​Folic acid​is a B vitamin that helps your body make red blood cells. If you don’t have enough red blood cells, you have ​anaemia​. Red blood cells carry oxygen to all parts of your body.

  1. b) write down the dietary sources of Folic acid

Good sources include:

  1. broccoli
  2. brussels sprouts
  3. leafy green vegetables, such as cabbage, kale, spring greens and spinach
  4. peas
  5. chickpeas and kidney beans
  6. liver (but avoid this during pregnancy)
  7. breakfast cereals fortified with folic acid
  8. Okra
  9. Beets
  10. Orange juice
  1. write down the importance of Folic acid in human body
    1. Helps your body form red blood cells and DNA
    2. Promotes normal growth and development
    3. May play a role in prevention of certain cancers
    4. Reduces your risk for heart attack and stroke
    5. Can Prevent some Birth Defects

 

Q2) a) define renal failure

Renal failure is defined as a significant loss of renal function in both kidneys to the point where less than 10 to 20% of normal GFR remains.

  1. b) difference between acute and chronic renal failure
Acute renal failure Chronic renal failure
1) Onset – over days to weeks Onset 1) Onset – over weeks to months
2) Reversibility – Invariably reversible 2) Usually Irreversible
3) Cause – Pre-renal or post-renal 3) Mostly Renal.
4) Urinary volume – Oliguria & Anuria. 4) Polyuria & Nocturia.
5) Renal failure casts – Absent 5) Renal Failure casts – Present.
6) Specific Gravity – High. 6) Specific Gravity – Low & fixed.
7) Past history of renal disease – Absent 7) Present
8) Dialysis – Required for short period 8) Required repeatedly.
9) Renal transplantation – Not required 9) Required.

Q3) a) define leukemia

Definition It is a group of malignant disorder, affecting the blood and blood –forming tissue of the bone marrow lymph system and spleen.

  1. b) discuss the sign symptoms and diagnosis of Leukemia

Common leukemia signs and symptoms include:

  1. Fever or chills.
  2. Persistent fatigue, weakness.
  3. Frequent or severe infections.
  4. Losing weight without trying.
  5. Swollen lymph nodes enlarged liver or spleen.
  6. Easy bleeding or bruising.
  7. Recurrent nosebleeds.
  1. Tiny red spots in your skin (petechiae)

Diagnosis Of Leukemia

  1. History and physical examination
  2. Clinical features
  3. Blood Examination (work up)
  4. Peripheral blood examination
  5. Chest X ray
  6. Bone marrow studies: BM biopsy, imprint and aspiration.
  7. Flow cytometry
  8. Cytological differentiation and immunophenotyping: FISH, RTPCR, chromosome analysis

Q4) a) define ovarian cyst

ovarian cyst

An ovarian cyst is a semi-solid or fluid-filled sac within the ovary.

  1. b) discuss the causes and management of ovarian cyst

Cause Ovarian Cysts

  1. Polycystic ovary syndrome (PCOS) is a condition that causes lots of small, harmless cysts to develop on your ovaries. The cysts are small egg follicles that do not grow to ovulation and are the result of altered hormone levels.

Medical Management

  1. Watchful waiting (observation):​ An ultrasound scan will be carried out about a month or so later to check it, and to see whether it has gone.
  2. Hormonal birth control pills: prevent the development of new cysts in those who frequently get them.
  3. Analgesic (Pain relievers):​such as nonsteroidal ant-inflammatory drugs, opioids analgesic.

Surgical Management

  1. Laparoscopy (keyhole surgery)
  2. Laparotomy

 

Q5) a) define Fluid volume excess

Fluid overload or volume overload (hypervolemia) is a medical condition where there is too much fluid in the blood. Excess fluid, primarily salt and water, builds up throughout the body resulting in weight gain.

  1. enlist the clinical manifestation and nursing management of fluid volume excess

Signs of fluid overload may include:

  1. Rapid weight gain.
  2. Noticeable swelling (oedema) in your arms, legs and face.
  3. Swelling in your abdomen.
  4. Cramping, headache, and stomach bloating.
  5. Shortness of breath.
  6. High blood pressure.
  7. Heart problems, including congestive heart failure.

Nursing Management of Fluid Volume Excess

  1. I&O and daily weights; assess lung sounds, oedema, other symptoms; monitor responses to medications- diuretics
  2. Promote adherence to fluid restrictions, patient teaching related to sodium and fluid restrictions
  3. Monitor, avoid sources of excessive sodium, including medications
  4. Promote rest
  5. Semi-Fowler’s position for orthopnoea
  6. Skin care, positioning/turning

Q6) a) define colorectal cancer

Colorectal cancer​is cancer that occurs in the colon or rectum. Sometimes it is called colon cancer

  1. b) discuss the risk factors and nursing management of colorectal cancer

Risk factors

  1. Genetics
  2. Family history
  3. Obesity
  4. Race
  5. Irritable bowel syndrome
  6. Type 2 diabetes

Nursing Management of Colorectal Cancer

1.Prevention is primary issue

2.Client teaching

3.Diet: decrease amount of fat, refined sugar, red meat; increase amount of fiber; diet high in fruits and vegetables, whole grains, legumes

4.Screening recommendations

5.Seek medical attention for bleeding and warning signs of cancer

6.Risk may be lowered by aspirin or NSAID use

Q7) write a short note on the following

1) CT scan

A computerized tomography (CT) scan combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels and soft tissues inside your body. CT scan images provide more-detailed information than plain X-rays do.

2) upper and lower GI endoscopies

Endoscopy is a procedure in which the gastrointestinal (GI) tract is viewed through a fiber-optic camera known as an endoscope, inserted either through the mouth (upper) to scan the oesophagus, stomach, and small intestines, or through the anus (lower) to examine the large intestine, colon and rectum.

3) ultrasound

Ultrasound is sound that travels through soft tissue and fluids, but it bounces back, or echoes, off denser surfaces. This is how it creates an image. The term “ultrasound” refers to sound with a frequency that humans cannot hear. For diagnostic uses, the ultrasound is usually between 2 and 18 megahertz (MHz).

4) barium studies

Barium studies are specialized X-ray examinations of the gastrointestinal (GI) tract such as the oesophagus, stomach, small and large intestines using a solution containing barium.

5)Biopsy (liver)

A liver biopsy is a procedure to remove a small piece of liver tissue, so it can be examined under a microscope for signs of damage or disease.

Adult health Nursing-I Solved past paper -2014

Q1) define cirrhosis of liver write its specific nursing management

Cirrhosis is a chronic progressive disease of the liver characterized by extensive degeneration and destruction of the liver parenchymal cells.

Specific Nursing Management

Nursing management for the patient with cirrhosis of the liver should focus on promoting rest, improving nutritional status, providing skin care, reducing risk of injury, and monitoring and managing complications.

Q2) define pancreatitis what are its clinical manifestations

Define pancreatitis

An inflammation of pancreas is called pancreatitis.

Clinical Manifestations

1.Pain in epigastrium region or in left upper quadrant

2.Constant pain

3.Low grade fever

4.Weight loss

5.Shock in severe condition

6.Nausea/Vomiting

7.Steatorrhea (fatty stool)

8.Decrease bowel movement

9.Breathlessness

10.Weak pulse

11.Low body temperature

12.Bluish discoloration of skin.

Q3) differentiate between peptic and duodenal ulcer

Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain. Peptic ulcers include Gastric ulcers that occur on the inside of the stomach.

A duodenal ulcer is a peptic ulcer that develops in the first part of the small intestine (duodenum). An oesophageal ulcer occurs in the lower part of your oesophagus. Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine.

Q4) define peritonitis and write its specific nursing management

Define peritonitis

An acute or chronic inflammation of peritoneum layer and peritoneal cavity.

Specific Nursing Management

1.Blood pressure monitoring

2.Medications

3.Pain management

4.I & O charting

5.Iv fluids

6.Drainage monitoring

Q5) define Iron deficiency anaemia write down its clinical manifestations and nursing management

Iron deficiency anaemia ​is a common type of anaemia — a condition in which blood lacks adequate healthy red blood cells. Red blood cells carry oxygen to the body’s tissues. As the name implies, iron deficiency anaemia is due to insufficient iron.

Iron deficiency anaemia signs and symptoms may include:

  1. Extreme fatigue.
  2. Pale skin.
  3. Chest pain, fast heartbeat, or shortness of breath.
  4. Headache, dizziness, or light-headedness.
  5. Cold hands and feet.
  6. Inflammation or soreness of your tongue.
  7. Brittle nails.

Nursing management

  1. Assess cardiovascular & respiratory status
  2. Monitor vital signs
  3. Recognizing s/s bleeding
  4. Monitor stool, urine, and emesis for occult blood
  5. Diet teaching—foods rich in iron
  6. Provide periods of rest
  7. Supplemental iron
  8. Discuss diagnostic studies
  9. Emphasize compliance
  10. Iron therapy for 2-3 months after the haemoglobin levels return to normal

Q6) define acute renal failure write down its specific nursing management

Renal failure ​is defined as a significant loss of renal function in both kidneys to the point where less than 10 to 20% of normal GFR remains.

Acute Renal Failure Nursing Management:

  1. Monitor for complications.
  2. Participate in emergency treatment of fluids and electrolyte imbalances
  3. Provide physical and emotional support
  4. Monitor fluid and electrolyte balance
  5. Reduce metabolic rate
  6. Promoting Pulmonary function

Q7) define urinary incontinence write down its clinical manifestations

Define urinary incontinence

Urinary incontinence is the involuntary leakage of urine. It means a person urinates when they do not want to. Control over the urinary sphincter is either lost or weakened.

1.Stress incontinence:​increased intra-abdominal pressure (sneezing, coughing, changing position)

2.Urge incontinence:​strong urge to void that cannot be suppressed (neurological dysfunction)

3.Reflex incontinence ​: hyper reflex in the absence of normal sensation (spinal cord injury)

4.Overflow incontinence:​over distention of the bladder (spinal cord lesions, tumours, strictures, prostatic hyperplasia.

5.Functional incontinence:​cognitive impairment, Alzheimer’s disease)

6.Lactogenic incontinence: ​Extrinsic medical factors (alpha-adrenergic agents

7.Mixed incontinence:​Combination of stress and urge incontinence