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 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)