Pathophysiology MCQs/BCQs

1) Total body water is:
1. 14L
2. 42L
3. 20 L
4. 28 L

2) All of the following are benign tumors, the most unlikely is:
1. Adenocarcinoma
2. Meningioma
3. Fibroma
4. Leiomyoma

3) Neutrophils predominate in acute inflammatory infiltrate during:
1. First 06 -24 hours
2. First 08 hours
3. First 04- 06 hours
4. First 24-48 hours

4) Most effective Bactericidal system in neutrophils is:
1. Halideion
2. MPOsystem (Myeloperoxidase)
3. NADPHoxidasesystem
4. MP0-H202Halidesystem

5) What is the most important prognostic factor for human cancer is proved to be of greater clinical value:
1. Stage
2. Vascular invasion.
3. Lymphocytic infiltration
4. Grade.

6) Most reliable feature that differentiates malignant tumor from benign is:
1. Local invasion
2. Metastasis
3. Irregular surface
4. Capsule

7) Regarding type – I hypersensitity:
1. Initial response is characterized by vasoconstriction
2. Late phase reaction occurs after few minutes
3. Develop after few days
4. Characterized by release of mast cell mediators

8) Reaction due to injection of horse serum (serum sickness) is example of:
1. Type – IV hypersensitivity
2. Type – Il hypersensitivity
3. Type – Ill hypersensitivity
4 Type – I hypersensitivity

9) Antibody mediated hypersensitivity does not occur in:
1. Erythroblastosis fetalis
2. Autoimmune Hemolytic anemia
3. Arthus reaction
4. Transfusion reaction

10) A 50 years old male develops sudden severe abdominal pain radiating to back. His lab values shows raised Amylase level. Regarding this case fat necrosis may occur in which of the following organ:
1. Brain
2. Skeletal muscle
3. Pancrease
4. Heart

 

11) Regarding Necrosis, which of the following statement is true:
1. Pancreas shows coagulative necrosis
2. Heart shows coagulative necrosis
3. Brain shows coagulation Necrosis
4. Heart shows liquefactive necrosis

12) In full term pregnancy, which one of the following cell adaptation has maximum contribution to increase in the size of uterus?
1. Dystrophy
2. Hyperplasia
3. Anaplasia
4. Atrophy

13) AIDS can be transferred through following factors except:

1.Inhalation
2. Blood
3. Direct contact
4. Saliva
14) All of the following are malignant tumors, the most unlikely is
1. Adenocarcinoma
2. Fibrosarcoma
3. Teratoma
4. Leukemia

16) Which of the following complement proteins may act as Opsonins:
1. c3b
2. C3a
3 C5b 9 complex
4. C3a & C5a

17) All of the following are malignant tumors, the most unlikely is:
1. Leukemia
2. Adenocarcinoma
3. Fibrosarcoma
4. Osteoma

18) Which one of the following mediator causes, chemotaxis of the leukocytes?
1. C1
2. C5a
3. c2a
4. C4

19) Granuloma with caseous necrosis is seen in:
1. Lymphoma
2. Tuberculosis
3. Sarcoidosis
4. Foreign body granuloma

20) Which of the following lab diagnostic technique is most convenient and suitable for the initial diagnosis and management of the patient suffering from swelling infront of neck (goiter)?
1 Smear
2. FNAC
3. Immunohistochemistry
4. Biopsy

 

21) ———— is also called Cytotoxic Hypersensitivity because it utilizes antibodies that can destroy normal cells by complement lysis or by antibody-dependent cellular cytotoxicity
1. Type-ll hypersensitivity
2. Type-l hypersensivitiy
3. Type-IV hypersensivitiy
4. Type-ll hypersensivitiy

22) Most common chornic inflammatory cells are:
1. Neutrophils
2. Macrophages
3. Eosinophils
4. Plasma cells

23) Malignant tumor arising from mesenchymal tissue is most likely called as:
1. Adenomna
2. Sarcoma
3. Hepatoma
4. Fibroma

24) Metastasis of cancer most unlikely occur by:
1. Lymphatic spread
2. Direct seeding of body cavities
3. Aerosol droplet
4. Hematogenous spread

25) Regarding anaplasia which of the following statement is true:
1. Nuclear to cytoplasmic ratio 1:6
2. Increase mitosis
3. Well differentiated cells
4. Normal size of shape of cells

26) Laboratory test most commonly used for diagnosis of AIDS is:
1. ELISA
2. EASTERN BLOT
3. RIBA
4. WESTERN BLOT

27) Multiple sclerosis is example of:
1. Type – l hypersensitivity
2. Type- IV hypersensitivity
3. Type-Ill hypersensitivity
4. Type – I hypersensitivity

28) Generalized edema through the body is termed as:
1. Anasarca
2. Anaplasia
3. Sarcoma
4. Pitting edema

29) Major component of innate immunity are all of following, the most unlikely is:
1. Epithelial barrier
2. B-lymphocyte
3. Complement proteins
4. NK cells

30) A 40 years old male suffering from cervical lymphadenopathy. Biopsy report shows granuloma with caseous necrosis. The most likely diagnosis will be
1. Tuberculosis
2. Sarcoidosis
3. Lymphoma
4 Foreign body granuloma

 

31) Pathological hyperplasia of thyroid gland occurs in:
1. Thyroid connective tissue
2. Thyroid follicles
3. Whole thyroid tissue
4. Thyroid stroma

32) A 55 years old female with ovarian Carcinoma developed ascities. Cytological analysiss of ascitic fluid show malignant cells. Which of the following pathway best explaining the spreading of tumor to the peritonium:
1. Seeding of body cavity
2. Lymphatic spread
3. Hematogenous spread
4. Direct Extension

33) Weakness and wasting of the body due to severe chronic illness is referred to:
1. Neoplasm
2. Cachexia
3. Anorexia
4. Fatigue

34) Which of the following is earliest stage of vascular events of acute inflammation?
1. Vasodilation
2. Initial vasoconstriction
3. Redness
4. Leukocytic migration

35) Increased concentration of potassium in the blood is termed as:
1. Hypernatremia
2. Hyperkalemia
3. Hypokalemia
4. Hyponatremia

36) Loss of uniformity of cells & Ioss of arachitectural orientation is most likely called as:
1. Desmoplasia
2. Metaplasia
3. Dysplasia
4. Anaplasia

37) Arthus reaction is example of:
1. Type – lll hypersensitivity
2. Type – II hypersensitivity
3. Type- IV hypersensitivity
4. Type – I hypersensitivity

38) All are causes of atrophy, the most unlikely is:
1. Diminished blood supply
2. Denervation
3. Decrease workload
4. Increase workload

39) Excessive intake of acid containing foods and beverages may lead to development of:
1. Metabolic acidosis
2. Respiratory alkalosis
3. Metbolic alkalosis
4. Respiratory acidosis

40) In full term pregnancy, which one of the following cell adaptations has maximum contribution to increase in the size of uterus?
1. Dystrophy
2. Hyperplasia
3. Anaplasia
4 Atrophy

41) Goodpasture syndrome is example of:
1. Type -Ill hypersensitivityy
2. Type – I hypersensitivity
3. Type-ll hypersensitivity
4. Type – IV hypersensitivity

 

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)

 

 

 

Sensory and Motor Neurons

Difference between Sensory and Motor Neurons

Sensory Neuron Motor Neuron
Neurons that carry sensory impulse from sensory organs to the central nervous system are known as sensory neurons A neuron that carries motor impulses from the central nervous system to specific effectors is known as motor neurons.
They are located in the dorsal root ganglion of the spinal nerve They are located in the ventral root ganglion of the spinal cord.
It is unipolar It is multipolar
Comprises of a short axon Comprises of a long axon
An adult has an average of 10 million sensory nerves in the body Half million of motor neurons are found in the body
Found in eyes, skin, ears, tongue and nose Found in muscles and glands

 

Lateral wall of nose

Short essay on lateral wall of nose:

The lateral wall of the nasal cavity is a region of the nasopharynx essential for humidifying and filtering the air we breathe in nasally.

Here we can find a structure called agger nasi. The agger nasi is also referred to as the ‘nasoturbinal concha’ or ‘nasal ridge.’ It can be described as a small mound or ridge found in the lateral side of the nasal cavity. The structure is located midway along the anterior aspect of the middle nasal concha. An abnormally enlarged form may restrict the drainage of the frontal sinus by obstructing the frontal recess area.

The lateral cartilage (upper lateral cartilage, lateral process of septal nasal cartilage) is situated below the inferior margin of the nasal bone, and is flattened, and triangular in shape.

Surfactant

What is surfactant and what is its function?

Surfactant is a mixture of fat and proteins made in the lungs. Surfactant coats the alveoli (the air sacs in the lungs where oxygen enters the body). This prevents the alveoli from sticking together when your baby exhales (breathes out).

Its classically known role is to decrease surface tension in alveolar air spaces to a degree that facilitates adequate ventilation of the peripheral lung.

Physiology of the eye

What is the physiology of the eye?

The eye is composed of a series of lenses and spaces that give focus to images, just as a camera does. It is composed of the vitreous humor, aqueous humor, the crystalline lens, and the cornea, and each of these has its own refraction index (the average being 1.34, because of the content of these tissues).

Physiology of the Eye

The primary function of the eye is to form a clear image of objects in our environment. These images are transmitted to the brain through the optic nerve and the posterior visual pathways.

The various tissues of the eye and its adnexa are thus designed to facilitate this function.

The Eyelids

Functions include: (1) protection of the eye from mechanical trauma, extremes of temperature and bright light, and (2) maintenance of the normal precorneal tear film, which is important for maintenance of corneal health and clarity.

The Tear Film

The tear film consists of three layers: the mucoid, aqueous and oily layers.

The mucoid layer lies adjacent to the corneal epithelium.It improves the wetting properties of the tears.

The Cornea

The primary function of the cornea is refraction. In order to perform this function, the cornea requires the following:

  • transparency
  • smooth and regular surface
  • spherical curvature of proper refractive power
  • appropriate index of refraction.

The Aqueous Humour

The aqueous humour is an optically clear solution of electrolytes (in water) that fills the space between the cornea and the lens. Normal volume is 0.3 ml. Its function is to nourish the lens and cornea.

The Vitreous Body

The vitreous consists of a three-dimensional network of collagen fibers with the interspaces filled with polymerized hyaluronic acid molecules, which are capable of holding large quantities of water.

The Lens

The lens, like the cornea, is transparent. It is avascular and depends on the aqueous for nourishment.

It has a thick elastic capsule, which prevents molecules (e.g., proteins) moving into or out of it.

The Ciliary Body

The ciliary muscle (within the ciliary body) is a mass of smooth muscle, which runs circumferentially inside the globe and is attached to the scleral spur anteriorly.

Accommodation

Accommodation is the process whereby relaxation of zonular fibers allows the lens to become more globular, thereby increasing its refractive power.

The Retina

This is the “photographic film” of the eye that converts light into electrical energy (transduction) for transmission to the brain.

Laryngeal Cartilages

The larynx consists of nine laryngeal cartilages: three are single (epiglottic, thyroid, cricoid) and three are paired (arytenoid, corniculate, and cuneiform).

  • Thyroid:
    • Largest of the cartilages
    • It is composed of two plate-like laminae that fuse on the anterior side of the cartilage to form a peak, called the laryngeal prominence, known as the Adam’s apple.
    • Its posterior border is elongated both inferiorly and superiorly to form the superior horn of thyroid cartilage and inferior horn of thyroid cartilage.
  • Cricoid:
    • Only laryngeal cartilage to form a complete ring
  • Epiglottic cartilage:
    • Consists of elastic cartilage, giving flexibility to the epiglottis
    • Almost entirely covered in mucosa
    • Its stalk projects superiorly and attaches to the posterior aspect of the tongue, so that during swallowing the epiglottis will move to cover the respiratory opening, thus keeping food out of the lower respiratory tubules
  • Arytenoid:
    • Pyramid shaped
    • Anchor the vocal cords
  • Corniculate:
    • Attach to the apices of the arytenoid cartilages
  • Cuneiform:
    • Do not directly attach to other cartilages