Biyani's Think Tank Concept based notes Medical Surgical Nursing -I (GNM) Jitendra Kumar Deptt. of Commerce & Management Biyani Girls College, Jaipur 2 Published by : Think Tanks Biyani Group of Colleges Concept & Copyright : Biyani Shikshan Samiti Sector-3, Vidhyadhar Nagar, Jaipur-302 023 (Rajasthan) Ph : 0141-2338371, 2338591-95 Fax : 0141-2338007 E-mail : acad@biyanicolleges.org Website :www.gurukpo.com; www.biyanicolleges.org First Edition : 2011 While every effort is taken to avoid errors or omissions in this Publication, any mistake or omission that may have crept in is not intentional. It may be taken note of that neither the publisher nor the author will be responsible for any damage or loss of any kind arising to anyone in any manner on account of such errors and omissions. Leaser Type Setted by : Biyani College Printing Department Medical Surgical Nursing –II 3 Course Description This course will help students understand the concept of disease and disease process. Student, will be able to gain knowledge and develop understanding of various medical, surgical disorder and disease. They will be able to give comprehensive nursing care to patients with these disease. General Objective Upon completion of this course the student will able to: 1. Describe the causes, symptom, treatment and prevention of medical surgical disease. 2. Demonstrate skill in carrying out nursing technique and procedures with the application of scientific principles. 3. Discuss nursing process and provide nursing care to patients with medical surgical disease. Course Content Unit I Introduction – Brief history of evolution of modern medicine and surgery and theories of illness and it causation. – Illness as human experience. – Nursing process and nursing care plan. – Unit Ii Nursing Assessment – Health Assessment – Physical examination – General clinical investigation – Unit III Patho Physiological Mechanism of Disease – Inflammation – Stress adaptation 4 – Defense against injury. – Nutritional consideration. Unit IV Altered Immune Response – Review of Normal Immunity. (Review Unit IV of microbiology) – Altered Immune response, Hypersensitivity and allergy – Nursing management of Immune therapy. – Auto immune disease – Graft versus host disease – Unit V Clinical Pharmacology – Terminology – Drugs and laws. – Basic clinical pharmacology – Sources of drugs, action, side effects, doses and drugs – Different pharmacological preparations. – Administration of medicine to patient. – Nursing implication of administration of drugs. – Unit VI Nurse's role in Management of fluid, electrolyte and Acid base balance – Water content of body. – Homeostasis – Review mechanism of controlling fluid and electrolyte movement – Review regulation of fluid and electrolyte. – Fluid and electrolyte imbalance and their therapeutic management. – Unit VIII Management of Patients in Pain – Concept – Assessment – Types, location Medical Surgical Nursing –II – Nursing management – Analgesic management – Analgesic drugs – Therapeutic approaches to pain. 5 Unit VIII operation theatre technique – Operation theatre; cleaning of rooms, tables, trolleys, lights and other equipments. – Pre-operative holding area. – Theatre Technique – Scrubbing-hand washing – Gowning – Gloving – Positioning of patient for various surgical procedure – Preparation of Theater equipment & supplies – Cleaning – Packing – Sterilization – Needles, sutures-types and their uses. – Role of a nurse in care of patient in the theatre. Unit IX Management of patient Undergoing Surgery Assessment of pre-operative patient – Physical, psychosocial physiology aspects – Nursing management of pre-operative patient. Intra Operative Management – Surgical Team – Nurse's function in Operation Theater. – Anesthesia; classification, anesthetic agents and role of a nurse in anesthe Post-operative management-immediate and Routine 6 – Transferring patient from Operation Theatre. – Patient in recovery room – Recovery from anesthesia. – Post – Operative nursing management – Administration of post-operative orders – Post-operative complications; observation, prevention and management Unit X Nursing Management of patient with impaired respiratory function a gaseous exchange. – Assessment of respiratory functions. – Management of patient with impaired respiratory functions. – Respiratory intensive care. – Management of patient with disorders of upper respiratory tract. – Management of patients with disorders of the chest and lower respiratory tract. Unit XI Nursing Management of patients with digestive and gastro-intestinal disorders. – Assessment of hepatic an biliary function. – Management of hepatic and billary disorders – Assessment of endocrinal function. – Management of endocrinal disorders. – Unit XIII Nursing Management of patients with renal and Urinary Disorders – Assessment of renal urinary functions. – Managements of patients with urinary and renal disorders. – Renal failure and dialysis. – Renal transplant. – Unit XIV Nursing Management of patients with neurological disorders – Assessment of neurological function. – Management of patients with neurological dysfunctions Medical Surgical Nursing –II – 7 Management of patient with neurological disorders. – Unit XV Nursing management of patients with disorders of connective tissue and collagen disorder – Assessment – Management of patients with disorders of connective tissue and collagen. – Unit XVI Nursing Management of the Elderly – Assessment of elderly – Ageing process – Helping in promoting wellness and self care. – Health problems in elderly Unit XVII Emergency Management – Medical surgical emergencies – Nurse's role in emergency conditions. 8 Unit I The Nursing Process Q.1 Define nursing process? Ans. The nursing process is define, problem solving approach too meeting the health care and nursing needs of a patients. It involves assessment (Date Collection) nursing diagnoses, planning implemented that promotion the health through the nursing diagnosis. Steps in the Nursing Process:1. Assessment: Systematic collection of data to determine the patients health state and to identify any actual or potential problems. 2. Nursing Diagnosis: Identification of actual or potential health problem that are amenable to resolution by means of nursing actions. 3. Planning: Development of goals and a plant of nursing care. 4. Implementation: Actualization of the plan of core through nursing interventions. 5. Evaluation: Determine of the patients responses to the nursing interventions and of the extent to which the goals have seen achieve. Nursing Care Plan: Nursing plan one involve from admission to discharge nursing care. At first assess the complaints of patient and then provide the nursing core on base of nursing diagnosis. I. Nursing Interventions II. Evaluation (Outcome) Q.2 Define disease, end it's course? Ans. A state of the body in which one or more ports of body foul to work. – Courses disease: 1. Hereditary disorder Medical Surgical Nursing –II 9 2. Physical end chemical agent. 3. Drugs, cigarette and alcohol excess of heat or cold electricity or reductive substance, physical injury. 4. Uncontrolled growth resulting in cancer. 5. Living organism – Bacteria, fanges virus, parasites 6. Disorders of immune system 7. Metabolic dirorder – hormonal, malnutrition 10 Unit II Nursing Assessment Q.1 Define Health assessment? Ans. Health assessment 18 a continuous, systematic process in which assess the physical and psychological need of on in divided. o Health assessment are divided in two types 1. Health history- collection of subjective information 2. Physical examination – collection of objective information's o Health history are divided in following information's 1. Socio-economization 2. Family history 3. Past medical history 4. Surgical history 5. Obsterical history 6. Present medical history Q.2 Define physical examination? Ans. It is a thorough inspection or a detailed study of the entire body or some port of the body to determine the general physical or mental conditions of the body. Physical or mental conditions of the body. Methods of physical examination 1. Inspection 2. Palpation 3. Percussion 4. Auscultation 5. Manipulation 6. Testing reflexes Medical Surgical Nursing –II 11 Visual examination of the body is called inspection. Palpation: It is the feeling of the body or a port with the hands to note the size and positions of the organs. In palpation the finger pacts and not the finger tips are used. Percussion: It is the examination by tapping with the fingers on the body to determine the condition of the internal organs by the sounds that are produced. Auscultation: It the listening to sounds with in the body with the aid of a stethoscope, foetoscope, or directly with the car placed on the body. Monipulations: It the moving of a part of the body to note its flexibility. Limitation of movements is discovered by this method. Testing of reflexes: The response of the tissue to extend stimuli & tested by means of percussion hammer, safety pin wisp of cotton hat and cold water. Q.3 Explain the role of nurse in nursing assessment? Ans. Preparation of the environment: Maintenance of privacy Lighting Comfortable bed or examination table. The room should be warm and without draughts. Preparation of the equipment Preparation of the patient. Physical preparation mental preparation Provide psychological support, and explain all details to the patient. 12 Unit III Patho Physiological Mechanism of Disease Q.1 Define inflammation and explain it's type? Ans. Immediate response protective's of tissue against any injury, infect chemical and physical agent than protective response is called inflammation. It is characterized by pain, heat, redness, sidling and loss of function of the affected port. Patho physiology: - The blood vessels of affected port are dilutees and blood flow fast. The WBC enters in the affected tissue space and engulf the bacteria and foreign particles and than consumer the dead tissue after that inflamed (Pas) condition on occur. Types of Inflammation: 1. Acute inflammation: Redness, swelling 2. Chronic inflammation: (Bacterial infection) pas formed 3. Other's Educative : Inflammation with the accumulation of blood cells and the serum. Bacterial: Inflammation produced by the growth of bacteria Reaction inflammation: Inflammation produced and a foreign body or dead tissue. 4. Serous inflammation: The inflammation in which the exudates and composed of serum. 5. Supportive: The inflammation in which pus is formed. 6. Traumatie: Inflammation caused by on injury. 7. Ulcerative inflammation: The inflammation over which on clear is formed. Medical Surgical Nursing –II 13 Stages of Inflammation: 1. Traumatic: After injury the edge of wound are edematous. 2. Destruction: By the macrophages the necrotic material remove and malformation are started. 3. Proliferation: This stage lasts 14 days. The film of connective and epithelium are around of wound. 4. Maturation: The dead cell are disappear slowly and wound healing stated. Q.2 Write short note on thrombosis? Ans. The information of blood clot in any port of circulatory system the condition is called thrombosis. 1. Stasis [stop the blood flow] 2. Pain, redness swelling tenderness, limbis feel heavy, superficial veins prominent, oedema of the extremities may be present or…. 3. Diagnosis : By sign and symptoms 4. Management: Non pharmacological management Apply heat Use of compression device Adequate bed rest Pharmacological management 1. Anti coagulant therapy 2. Thrombolytic therapy Nursing management Provide bed rest The legs are elevated of the level of heart. Provide anti coagulant therapy Assist in breathing exercise 14 Monitor the vital sign Elastic compression stoking Non steroidal anti inflammatory drugs are present in case of pain Educate the patient absent personal hygiene. Medical Surgical Nursing –II 15 Unit V Clinical Pharmacology Q.1 Define medicines? Ans. Medicines may be defined as a substance used to promote health to prevent illness to diagnose to alleviate or cure disease. Administration of medicine is one of the greatest responsible of a nurse. She should see that all medicines are administrative in such a way as to obtain best results for this she should have a through knowledge of the drugs that is administered by her. Q.2 What are the 5 rights for a safe administration of drug or Essential of a medication order? Ans. The drug order written by the physician has essential ports: 1. None of the patient: To identify the patient correctly and to avoid confusions when there are more then one patient with the some name. 2. None of the drug: The name of the drugs should be written clearly and correctly. 3. Dosage of the drug: The dosage of the drug includes the amount, the strength and the frequency of administration. 4. The method of administration: It is not consumed for a drug to have several possible routes of administration. Then fore it is important to specify the route of administration in the drug order. 5. The date: The date will include the drug. The month and the year, some times the time when the order written is also included. The signature of the physician: The signature of the physician makes the drug order a legal request an unsigned order has no validity. 16 Q.3 What are the types of preparation of drugs? Ans. Medicines are available in the market indifferent types of preparation. The preparation may determine the method of administration. The following are the last of pharmaceutical preparations of drugs: 1. Aqueous salvation: One or more drugs dissolved in water. 2. Capsule: Powdered drugs or liquids within gelatin container 3. Elixir: Solution containing of fat sugar and water. 4. Emulsion: Dispersions of fat globules in water. 5. Lotion: Drugs in liquid suspension intended for external use. 6. Ointment: Semisolid preparations of a drug or drug in petroleum (Vaseline) 7. Pill: Single dose units male by mixing the powered drug with a liquid such as syrup and rolling the mixture into round or oval shape. It is replace today by tablets and capsules. 8. Solutions: Liquid preparation s containing one or more substance completely dissolved in salved. 9. Syrup : An aqueous solutions of sugar often used to disguise imp easement testing drugs and soothe irritated membrane. 10. Tablet: Single dose units made by compressing powdered drug into small hard discs. Some are readily broken along a scored line, some are enteric coated to prevent irritation to gastric mucosa or to prevent the effect of the gastric secret upon the drug. Q.9 Explain the classification of drugs? Ans. Classification of drugs: Drugs are divided into several types according to their action on particular system, composition, their purposes & used etc. According to action drugs are classified into following types. Anesthetics: Drugs used to sedate patient i.e. loss of sensation. Analgesics: Drugs used to relieve pain. Anthdminthics & vermifuges: Drugs used to destroy & expel worms. Medical Surgical Nursing –II 17 Antipyretics: Drugs which reduced fever. Anti infective: Use to reduce infection by killing the micro organism or inhibiting their growth. Antidotes: Substances used to counteract the effect of poison. Anti-inflammatory: Drugs help to reduce the inflammation. Anti-Coagulants: Substances decrease clotting of blood by reducing clotting factor formation. Anti histamines: These are the agents used to reduce inflammation or prevent allergies. Antacids: These red acc the HC production by blocking H2 Anti- convulsants: These are used to treat fits or convulsions. Antibiotics: Products of living micro organism that have the ability to destroy or inhibit the growth of other organism. Anti diarrheal: Drugs used to treat diarrhea either by detoxicating the noxious substances or by killing the infectious gastro intestinal micro-organisms or merely the the irritated bowel mucosa & reduce the spasm. Antiussives: These act on the cough centre present in central nervous system & inhibit the cough reflex. Anti asthmatics: This relaxes the smooth muscles of the bronchioles & provide relie. Androgens: Hormones secreted by the tests & the adrenal cortex. They are steroids which can be symhesized to produce the secondary male characteristics & building up of provide tissue. Anti purities: A drugs that relives itching. Anti Phlogiston: A substance that prevent the infection by inhibiting the growth of microorganism. Astringent: A drug that causes the contraction of tissues & stop discharge. Anti fungal: Drugs which prevent the growth of fungi of tissues & stop discharge. 18 Antispasmodics: An agent that relives the spasmodic pains or spasm of the muscles. Antiseptics: Prevent nausa & vomiting. Anti tubercular: Drugs used to treat tuberculosis. Antirheumatic: Drugs used to treat rheumatism. Bronchodilators: Drug relax muscles & help in the expansion of lungs. Coagulants : Drugs help in the slowing of blood by forming clotting factor. Carminatives: Drugs used the cause intestinal evacuation, they are subdivided as follow: Drastic: Have a violent action. Laxatives: Relive constipation. Hydrogogues: Produce watery stool. Purgatives: These are laxatives but more powerful. Cholagogues: These are durgs which increase the bile secretion. Cortico-steriods:These are anti-inflammatory drugs use to prevent inflammation. Caustics:Substances that are destructive to living tissue. Diuretics: Increase the urine output Demulcents: Substances that softens, soothe & protects mucus membrane. Digestion: An agent that promotes diagesion. Emetics: Drugs producing vomiting. Ecbolics or oxytocies: Drugs that stimulate uterine contraction. Expectorants: Drugs increase bronchial secretions & aid in the expulsion of the mucus. Emnagegues: A drug that improve the menstrual periods. Emollient: Substances that smoothens, softens & protects the skin. Galactagogue: Substances that increase the flow of milk. Hypnotics: that induce sleep Haemostatics: an agent to check haemorrhage. Medical Surgical Nursing –II 19 Hypotensive: Any substance capable of reducing blood pressure. It implies a persistent effect as opposed to the fleeting effect of a depressor. Hypoglycaemics: Drugs that lowers the bloos sugar level. Haematinies: An agent which tends to increase the haemoglobin consult. of the blood. Hormones: They are the substitutes for body hormones. Keratolytics: Drugs which softens the horny layer of the skin & helps its removal. Mydriatics: Dialate the pupil of the eye. Myotics: Dilate the pupil of the eye. Myotics: Contract the pupil of the eye. Muscle: Relaxants: Agents used for diminution on tension or functional activity of muscles. Nasal decongestants: Drugs produce shrinkage of the engorged nasal ………….& relieve the nasal congestion. Narcotics: A drugs that produces stupor or complete in sensibility. Scabicides: A class of topical anti infectives used in the treatment of scabies. Stypies: An agent that check haemorrhage. Sedative expectorants: Drugs which lesion parosymal couogh & made it more effective by soothing the inflamed respiratory mucosa. Stimulant expectorant: Drug used to increase the bronchial secretion by irritating the bronchial mucosa. Sulphonamides: Antibacterial drugs & have a chemical resemblance to para amino benzoic acid (PABA) a substance needed for the metabolism of micro organism. Normal utilization of PABA is inhibited when sulphonamide are present. Sedatives: Lession the body activity. Stimulants: Increase the functional activity of an organ or system. Specific: Have a special curative action in certain disease. 20 Stomachies or gastric tonics: Drugs which increase appetite & promote digestion. Tranquilizers: These are a class of drugs whose principal effect is to calm, nervous, ansious, excited or disturbed patients without affecting the clarity of consciousness. Thyroid: The cleaned, dried & powered thyroid gland administered orally in the treatment of thyroid deficiency state. Vesicants: A blistering agent. Vermifuge: A drug that expels worms or intestinal parasites. Vasodilators: Drugs or agents that cause constriction of blood vessels with the effect of raising the blood pressure. Urinary antiseptics: Any one of the organic or inorganic compounds when administered in secreted by the kidneys & either stops of inhibits the growth of bacteria in the urinary tract. Medical Surgical Nursing –II 21 Unit VI Altered Immbre Response Q.1 Define Immunity with classification? Ans. Immunity refers to resistance of a hest of pathogens and their toxie products it is two types. 1. Innate Immunity: It is due to genetic and constitution make up and individual prior contract with micro organizer their products is not essential. It may be specific against a particular organism or non specific. Immute immunity may be further divided in two types. Non Specific Specific Immunity 2. Acquired Immunity: Most potential pathogens are clerk by innate immunity before they establish on overt infection. It these deference's are breached the acquired immore system 18 called into play. The resistance that on individual acquitting life time 18 known as acquired immunity. Q.2 Explain the acquired immunity on large scale? Ans. Acquired immunity are divided into types : 1. Active acquired immunity. 2. Passive acquired immunity. 22 Active Immunity Natured Artificial Vaccination Clinical Infection Subclinical Infection Live vaccine Killed vaccine Passive Immunity Natural Through Placenta Artificial Through Brest Milk Immune Seram Immune Cell (Fig 1 types of Immunity) Active immunity: Produced activity by hosts immure system as a results of Antigenic Stimulation Passive immunity: Received passively by the rost. No. participant of host immune system. Q.3 Explain artificial active immunity in vaccines form? Ans. This is the resistance induced by vaccines which are preparations of live or killed micro organisms or their products. 1. Bacterial vaccines: Medical Surgical Nursing –II [A] Live: B.C.G. for Tuberculosis Ty Z/z for typified [B] Killed: TAB for enteric fever Cholera Pertusis 2. Bacteria products – Tetonus foxoid – Dephtheria foxiod – Capsulor polysaccharide of meningo –cocci – Capsulor polysaccharide of haemophilus influence type 3. Viral vaccines: [A] Live: Sasin vaccine for palio myelitis or OPV 17D vaccine for yellow fever MMR Varicella Zoster. [B] Killed – Salk vaccine for paliomyclitis – Neural and non-neural vaccine for rabies – Influenza – Hepatitis A – Hepatitis B – Japanese encephalitis Q.4 Explain the factors influencing innate immunity? Ans. 1. Age: In general very young and very old are more susceptible to infectious diseases than persons in other in other age groups. 23 24 2. Hormonal influences and sex: There & on increases susceptibility to infection in endocrine disorders such as diabetes mellitus, hypothyroid, and adrenal dys functions. Pregnant women are more susceptible to microbial infection due to increased steroid level during pregnancy. 3. Nutritional factors: Both antibody mediated one cell mediated immunity are lowered in malnatrion. Medical Surgical Nursing –II 25 Unit VII Nurses role in Management fluid electrolyte and acid base balance Q.1 Define homeostasis, and explain distribution of body fluids. Ans. The balance between fluid and electrolyte in body that term is called homeostasis. The body fluid are divided in two types 1. Intra cellular 2. Extra cellular Intra Cellular are also called cellular fluid it means the fluid are present in body cells. The total amount pre 70%. Extracellular fluid are present out of body cell. It is divided in two types. Intravascular – Plasma and constitute Intrasitial fluid: Present in cell & space. Q.2 Define fluid and electrolyte imbalance and their therapeutic management in details. Ans. 1. Fluid imbalance: Intake 18 increase and output 18 decrease or intake 18 decrease orel out put increase than condition are called fluid imbalance. Due to fluid imbalance there are two problems create. 1. De-Hydration 2. Over – hydration Dehydration: The fluid intake in adequate than condition are dehydration. 26 Causes: 1. Profuse sweating in fever. Water evaporation from the body. Excessive use of directions. Sign and symptoms: – Dry skin – Weight loss – Coated tongue – Aligourea – Dark coloured urine – Hypotension – Increased thirst – Sunken eye boll – Diarrhoea Electrolyte imbalance : Sodium Hyponatremia: Leck of sodium in body. The sign and symptoms of Hyponatremia are: – Abdominal cramps – Convalsion – Tachy cardia – Coll and calmy skin Hypermatremia : Interested amount of sodium in body. The clinical features are: Dry mucous membrane Flushed skin Increased thrist Dry and tough tengue Monia Medical Surgical Nursing –II Fever Potassium Hypokalemia: Malaise, flabby, muscles, weak pulse hypotension, distention of abdomen. Hyperkalemia : collie oligocerea, irregular pulse. 3. Calcium (Ca+2) :Hypocalcemia : Tetony, abdominal distention, conversion, corpopedal spasm. Hyper calemia: This condition are occur due to excessive secretion of para thyroid glands hormone. Therapeutic management of fluid and electrolyte imbalance: Assessment: – Take the patient history – Monitor the vital sign – Take the client weight daily – Monitor the intake and output chart – Evaluate the energy and bevariour changes – Review the laboratory test Nursing diagnosis: 1. Activity intolerance related to muscles weakness. 2. Decreased cardiac output. 3. Fluid volume deficit related to diarrhear, vomiting polyurees. 4. Fluid volume excess related to anuria decreased cardiac output. 5. Risk of injury 6. Altered nutrition 7. Risk for impaired skin integrity rebutted to poor skin targor. 27 28 Nursing implementation: – Manage the fluid and electrolyte intake. – Administer the IV fluid. – [A] Fluids 1) Dextrose in water 2) Dextrose in Nacl 3) Nacl 4) Ringer solutions – manage the dehydration due to vomiting diarrhoea or inadequate intake. 5) Plasma expends (dextrin and albumin) in use of burn and trauma. (B) Regulation of flow note: – By manual with clomp – By infusion pump – By volume control (C) Monitor for complications – Pharmacologic management – Diuretics – Electrolyte replacement Provide general care – skin care, bed bath sponging mouth wash, hair core Provide psychological support. Evaluation : Maintain fluid balance Serum electrolyte levels are within normal limits Vital sign are with in normal limits. Medical Surgical Nursing –II 29 Unit VIII Management of patient in pain Q.1 Define pain with pain ratiny scale? Ans. Pain is warming signal that 18 related to tissue damage: According to international association for the study of pain (IASP) "An unpleasant sensory and emotional experience associated with actual or potential tissue damage". Pain is a personal or private sensation of any injury. Intensity: Pain rating scales are measure the pain intensity. 0 1 2 No Pain 3 4 5 6 7 distressing pain 8 9 10 un-bearable pain Location Right Left Front Left Right Posterior 30 Pattern of pain may be Constant Steady Intermittent Q.2 Explain the nursing management of pain? Ans. The primary nursing diagnosis & 1. Pain related to in tissue injury from on incision, ischemia, tumor, encroachment in organs or bone. Goal: Administer the pain reliving medicines. The route may be: by mouth, rectal, topically sublingually, inhalation or by injection. Provide the psychological support in pain condition. Educate the patient for self management of pain. Other nursing diagnosis are Activity intolerance Anxiety and fear Sleep pattern disturbance Knowledge deficit. Goal: Assist the patient in ADL (Activities of daily living) Provide proper rest and comfort. Provide psychological support. Provide cool and calm environment. Analgesics Drugs: 1. Non opioid drugs Aspirin Salicylate Medical Surgical Nursing –II Acetaminophen Non-steroidal anti-inflammation drugs (NSAID) 2. Opioid Drugs: Codeine Hydrocodone Incpridine 3. Side effect of analgesic drugs Gastric irrigation Increased clotting time Constipation Bleeding Naused and vomiting Respiratory depressions 31 32 Unit IX Operation Theatre Technique Q.1 Define O.T. Technique? Ans. O.T. Technique: Operation theater is as too lated unit of the hospital in which emergency and planned surgical procedure take place incomplete aseptic environment. There are also available emergency equipment and life sharing drugs. The of is also attech with anesthesia, sterilization, post recovery store rooms, changing room and scrubbing room. Set up of OT: 1. The wall should be hard and easily washable. The material like tiles or plaster should be avoided due to risk of Gacks where the micro organisms can harbor. 2. The floor should be smooth for easily washing and clearing. 3. The ledges or shelven should be avoided. 4. Extension board with rumors wire across the floor should be avoided. 5. Adequate air conditions should be provided is the OT. 6. In the absence of windows there should be adequate facility for lighting. 7. The fire escape should be present as legal requirement. 1. Anesthesia Room: The patient changes from his ward cloth in the OT cloth in this room. The reduce the contamination the room should be pleasant by decorated to help the patient pure to dedication. Medical Surgical Nursing –II 33 2. Sterilization Room: The sterilization room should be present near to the OT. There should be one window to exchange the articles of operation. 3. Recovery Room: There should be direct connection between the OT and recovery room. Where the patient is kept is post operative period fill the vital parameter stabilize. The recovery room contains central oxygen supply. Suction machine BP apparatus stethoscope I stand. Roller bandages, gauze piece, cotton swab, mouth gag, laryngoscope, pharyngeal air way, kidney tray, bed sheet blanket, tornicate, detribilator, ventilator and ECG machine cardiac monitor and life sharing drugs. 4. Store room: The store room contain extra cylinder N2, additional equipment and some prepare tray are available is the store room. 5. Changing room: A room should be available for the theatre personnel to charge the OT clothes, the food wear also provided is this room cap and mask also kept in this room. 6. Scrubbing room: The surgeon and nurse scrub in this room prior to wearing the sterile gown this room is also directly open in to the OT. Nursing is theatre: The role of nurse is to under stand the process of illness and to contribute, the skillfully about patient recovery. A theatre nursing must have special training or knowledge R/T aratomy & physiology and this order of whole body. She must also have knowledge about the complete aseptic technology such as scrubbing and growing the nursing process include following point. (A) Assessment: In the assessment use include collection of the biodata such as name of the patient registration number, diagnosis, investigation, any allergic from any drug or disease like HT, diabetes. The nurse must provide explanation about the problem related to operation nature. Its duration anesthesia, safety, complication out come and about the pain awareness. 34 (B) Implementation: It provide the nursing staff and opportunity to educate the patient and relieve the anxiety and stress. It also included preparative preparation technique of anesthesia, intra and post operative monitory with advareed equipments. 3. Evaluation: The findings of evaluation should be documents on the care plan. It also help is encouraging the health personnel's. Preparation of myotroccey: Retractor Niddle holder Scisors Sutures Sus force Bed cock forcep. Tissue for cep Kidney tray Elecro catutory Haemostate Dissecting forcep scalpel. Assisting: Assist the surgeon with fully aseptic technique and stop by step. Don't give any unassory articles during the time of operations. The mortally should be clear and bita deen before keeping the articles. The equipments should provide in such a way that there is noned to surgeon read justing them. The ligature are handed to surgeon grasp it with is two finger and between haemostate. Medical Surgical Nursing –II Q.2 35 What are the use O.T.? Ans. S.No. Position Name of site of operation 1 Supine or dorsal re Eye, nose 2 Tendelberg Intra pelvic surgery 3 Lelral Operation of kidney such as PCNC, letral part of chest and hip surgery. 4 Lethiotomy Operation of external genitalia vagina and perineum surgery 5 Neck position Operation of neck specially trachiostomy, thyroidectomy 6 Prone Cerebral operation, surgery of spinal reritibra 7 Sitting Special in the cranial surgery 8 Knee elbow It is use for lumber vertibra and it is also use for removal of prolops of intra vertebral disk. 9 Jack knee It is use for roctal surgery. Staff of operation theater: 1. Senior Manager: Maintain the high standard of the patient care. Planning and odering. Welfare of the professional development. Work as a liason between the surgery anasthatist, laundry department, pharmacy, department. 2. Theater sister: Daily management of theater. Order stock Liason between surgeon and arasthalist Observation of immediate sign and symptom before/after the surgery. 36 3. Scrubb nurse: (1) Before operation Collection of equipment and liner for operative patient with planning. Gowning an glowing Drawing the trathy. Collection of suture material such as catgat vicryl, niddle cutting and round, blade gauze piece and cotton etc. After draping the meytrally prepare the initially requirement cartides. Check the patient's identification such as name diagnosis and case paper. Ensure the safe positioning of patient. 2. At the time of operation: Toileting the skin of operative area and swab on the holder to the surgeon. Assist is draping of patient expose only needed area. The position of my table should be set according to the need of surgeon. Pass the instrument, gauze piece, spung and suture material to the surgeon according to need. Keeping and accurate court of extra instrument and spung and ensure that they are recorded by circulars nurse. 3. At the end of operation: Remove the instrument from the myotable. Collect the dressing from the circular nurse. Dispose the blade, niddle into the appropriate untainer. Remove the drap sheet from the patient. Ensure that the patient gown is clear and dry. Medical Surgical Nursing –II 37 Cover the patient with clear sheet. Entry should bedone is operation reg. 4. Circular nurse: A circular nurse is a person who helps the scrub nurse and is available through out the operation. (A) Before operation Ensure that the theater has been clear. Conform that the light suction and all equipment are is working condition. Ensure that the temp. also humidity is control. Prepare the sterile gloves and gown. Open the instrument bag, bowl pack and other equipment for the scrub nurse. (B) During operation: Available at all time during the operation. Count and dispose of spung. Ensure thest all the door and window, are dosed. Prepare the dressing tray for the wound dressing. (C) After operation: Helps is removal of design. She should also help in shifting the patient. Ensure that the patient is sattle and the vital perameter are with is the normal range. It there are any deviation is vital perameter shift the patient is PACU. Remove the instruments from the myotrauly, count this and send for auto calve. Afton washing the scissors they should be kept is formaling chamber. 38 Ensure that the theater is clear. The fumigation should be done from the two to three days. Preparation of operation site: 1. Skill operation Complete skill, for head neck and ear. 2. Face surgery: Sharing of face, neck ears 3. Is the eye operation the eye brow should be share. 4. Chest operation: (a) Supine part : Wid abdomes to sholder neck and thorax (b) Letral part: wid abdomes to sholder is charding the helral aspect of thora. 5. Abdomen's surgery: From nipple to upper part of thigs, extending the round wall and pelvis including the genital. 6. Genital Surgery: From umbilicus to hid thing and extending the letral round of pelvis including the genital and anal region 7. Anal region surgery: Appear part of the thing buttocks and oral risk. 8. Spinal surgery: From shoulder to the upper part of things including buttocks. Medical Surgical Nursing –II 39 Unit X Management of patient under going surgery Q.1 Define anesthesia with classification? Ans. Anesthesia: Anesthesia is a chemical substance that may be in the form of the gas. It helps in complete loss of sensation of whole body and any particular part of body, muscles relaxation and reduction of the reflexes of the body. Thasthesia: Amnesia analgesia + muscles relaxation + hypnosis Classification: (A) General Anesthesia : The agent that desensitize the whole body is called general anesthesia in this anesthesia the patient will be fally unconsciousness. It is mainly given by inhalation intravenous and intra rectal route. 1. Inhalation: In this anesthesia the liquid gas mix with the O2 and administer in to the lungs with respiration the purpose we can use O2 hask or endotrachial tube eg. Harlothare, ether, no chlsroform cydopropane. 2. Intravenous: These are liquid agent which are given by route. Barbiturate: theiopantone sodium katamine Narcotice : eg. Pathidine, morphine salpine Tranquelizer: Diazapal 3. Rectal anesthesia: These anesthesia are given by the rectal route and the agent is absorve by rectal mucosa. (B) Local Anesthesia: In this type of anesthesia the particular part of body anesthetized. On the basis of administration it also classified in the seven types. 40 (C) Topical: These agents are used on particular area on incession the agent block the nerve eadings eye, oral carity, and vagina. Infitration: The agent are procaive, cocaine. These agents are introduce with help of syringe and niddle eg lignocane. Field block anesthesia: These are simulate like infiltration anesthesia, but it is given sub of cataniusal. (4) Spinal anesthesia: These agent are given by lumbered punctured is sub archnoid space. This is given for the surgery of lower part such as resistectomy, LSCS, factor of the factor and pelvic surgery. Eg. Lox heavy 4%. (5) Epidural anesthesia: When the local anesthesia is given in the epidural space is called epidural anesthesia. This agent the neurological complication not occur. (6) Caudal Anesthesia: When the anesthetic agent it introduce in the coaloal space is called …………. Anesthesia it is given for percheal surgery. Q.2 Explain the role of nursing in Anesthesia? Ans. Role of nurse anesthesia: 1. Identification of Patient: It is important state find out the patient its diagnosis and registration no. assume that the patient is NBM. 2. Evaluation of record: Check the operation notes. Check the complete physical examination that has been done. Check the diagnostic study and all investigation. Ask the patient about any allergy from the drug. Medical Surgical Nursing –II 41 3. Maintain the adequate environment of operation theater: By checking the temperature and humidity of OT. By removing the amounts of the patient. By send out the unnecessary staff from the OT. 4. Psychological support: Explain the procedure, its duration and complication anesthesia aften surgery. Dean the all droughts by explain the patient for reduce the anxiety. A meting should be done of patient related to some surgery. 5. Wear the OT drugs: Give the gown to the point before entering is to OT. 6. Adequate positioning should be given to the patient and special precaution should be given about the spinal anesthesia to the patient that the light movement may cause neurological problems to the patients. 7. Prepared the emergency equipment: Suction apprates, life saning drug cardiac monition, O2 selerder, defibrillator, ambu bag ventilator. 8. Observe the any abnormal sign to the patient check the colour of skin 42 Unit XI Management of patient undergoing surgery Q.1 Explain the ICU nursing? Ans. Definition: ICU is an isolated unit in the hospital set up for caring of critically ill patient with all emergency equipment and godgets are fully computerized. The complex completely air conditions with selded to relative of the patient it should be fuly furniture, and duty for the ICU personnel. Set Up of ICU: The ICU should be situated near the operation theater. The ICU should not open directly in the gallery. According to norms of WHO and ISD the hundred bedded hospital must contain 10 bedded in the ICU. The set up of the patient must be around the nursing station. The ICU have separate laboratory for the emergency investigation. The floor and walls of ICU should be made with norbal and plaster of Paris. The ICU should be attached with the changing and utility room. No visitors should be allowed in the ICU and all the emergency equipment and life saving available such as : – Dopamine – Dubetamine Equipment or articles use enthe ICU: 1. Multi functional iron bed with railing system: Medical Surgical Nursing –II 43 2. Ventilator with multioptinal humidifier. 3. Suckion mechene, compressure and O2 slender supply of O2 in not available. 4. Cardiac monitor with ECG, NIBP [Non inrasive BP] IBP, capnea alarm, temp recording should be present. 5. Defibrillator machine. 6. Incubation kit. Laryngoscope Endo tracheal tube Stylate or guide wire Ambu Bag. And Vegalis forcep. 7. CPR-Troly [Cardiac pulmonary resistance] 8. Central monitoring system. 9. Pulse oximeter (SPO2 Monitor) 10. ECG machine 11. Portable X-ray machine 12. Arterial blood analysis (ABG) 13. Infusion Pump with syinge 14. Refrigerator 15. Vapour Box; (Formaldihyde) 16. Gluco meter 17. Water bed or ultra sonic bed 18. External cardiac pace makes kit 19. Tracheotomy tray. For long time incubation and present the laryngeal oedeema. 20. Warmerdevice 21. Hot water bottle and heater 22. Torch 23. Percussion hamour 44 24. Tangue depressua 25. Various type tray Cat down tray it not use none a days. It not use none a days. It is replace is to long line or central line. Bone mersow tray Lumber puncture tray Aspiration tray Dressing tray Bibulizer 26. View box 27. O2 flow meter 28. Vasal cathator 29. Over head ache. 30. Others Cathator Ng. tube ET Syring Gown, gloves, cap, mask Central line Lives 31. Emergency Drugs Nitro glycerine Oopamine Oobutamine Adrenater Atropin Corticosteroid Avil Medical Surgical Nursing –II 45 Dexona Lexis Sodaby carb. Calcium send Phenargin forthwin Xylocan Diazapin Nicardia Q.2 Define principles use in ICU? Ans. Principles use in the ICU: 1. Close observation of vital pera meter. 2. Prevention from recurrence of disease. 3. Main tain the naemodymanics of the patient. 4. Restore the life of the patient in life threatening situation. 5. Prevent from complication is the bed ridden patient by providing the good nursing care. 6. Daily bidding spun zing and MBBS care I mouth Bow, bladdes and skin care. 7. Maintain the potency of invasive monitory line. 8. Check the ventilatory adjustment [Tidal vol- 10 ml/kg of body and rate] 9. Maintain support chart. 10. Maintain support of central venous pressure [CVP] 12-16 MM H2O 11. Mention aureate flow of Ionotropic support. 12. Follow the fire rights of administration of drug. 13. Maintain the emergency medicine kit by checking the expirary dater intact level and any breakage. 14. Maintain the proper treatment and schedule of all records when handling and taking over the next staff in the awritten about any procedure, perameters, inversgation, admission and discharge etc. 46 15. Sens the specimen for ………investigation riobsy etc with well label. 16. Maintain the patience of ET takes by sickening of interval. 17. Inform the physician as soon as possible for any complication and abnormal symptoms. Role of nurse in ICU Nursing: Maintain the patient airway: Assessment of patient by observing the airway. Check the level of cyanosis Check the tangue fall. Check and present the aspiration Check the pharyngeal airway. Remove the obstruction by NaHCO3 Give the adequate positioning to the patient. Check the humidification level. Check the brathing level. 2. By maintaining the berating petering: Maintain the adequate environment for breathing pattern. Check the spo2 level Remove any obstruction in the air way Chest physio therapy may be given adequate position to the patient. The central supply of O2 should be start it the saturation is low. 3. Maintain the circulation: The circulation can be maintain by checking the vital perameter. Maintain the hydration of the patient. Check the IV canulla for any complication such as thrombus. Medical Surgical Nursing –II 47 Measure the crp. Check the urinary output in emergency take the patient on ionatrople support. Maintain the adequate pose toning. Diuretics should be given in the patient of retention of the fluid. Sodium restricted diet should be given. 4. Cardiac function: ECG monitory Health education about diet and exercise. Nitro glycerin. Dopamine and doubtamine Sedatives 5. Maintain the body temp 6. Other: Maintain the adequate record of Patient and articles of ICC such as lives planket etc. Check the monitory of ventrilator. 7. Check the skin integrity and provide the good nursing care for the bed ridder patient. 8. Follow up of health teal should be given to patient and relation R/T disease and and nursing care given he the home. Care of ventilator: Ventilator: It is a mechanical device which is use to maintain the respiratory balance or who help the patient when he is unable to take the spontaneously breathing. It also helps to maintain the arterial blood gos with in the normal limit. Care of ventilator: 48 1. The ventilator should be check before connecting to the patient for it's functions such as volume, rate and mode setting. 2. The Humidifier should be is on condition and the water level should be adequate. 3. The tabbing of venlilator should be use disposable types if reusable tubing & are using it should be disinfected. 4. The transducer fitter and loms should be disinfected prior to use by 70% phenol. 5. The tube should and dusting of ventilator should be necessary at inteivel 6. The avessuries of ventilator should be kept in arsoblue place. 7. The filtered should be abodave after each patient. Medical Surgical Nursing –II 49 Unit XII Nursing management of patient with impaired respiratory function and gaseous exchange Q.1 Define COPD Write down the aetiology, SIS and management? Ans. Chronic obstructive pulmonary disease is also known as chronic obstructive long disease. COPD is the group of various disorders, known as asthma, bronchitis, and emphysema. Incidence: It is more common in old age and makes are more affected than female. Risk factors: Smoking is the major risk factor for COPD. Asthma: Asthma is a disease of branchial airway which is characterized by narrowing of airway due to respect and reversible bronehio spasm occur. Asthma is characterized by three basic events : Branchiopasm Excessive mucus secretion Oedema Branchitis: Inflammation of the branchi is known bronchitis in which excessive mucus is secreted which causes cough. Emphysema: Emphysema is a disorder in which alveolar walls are destroyed and permanent over distention of alveoli and long tissues, occur due to accumulation of air in it. Aetialogy: 1. Cigarette smoking, infeetions air pollution 50 2. Inhalation of physical and chemical irritants 3. Environment factors – Temperature, air, homiletic 4. Stress & emotional upset. 5. Medications – Aspirin and NSAID, B-Blockers Clinical Features: 1. Asthma: Continuous coughing, chest pain, wheezing, chest tightness, restlessness, dyspnoe cyanosis and attack may be sudden or gradually. 2. Bronchitis: Productive cough, wheezing sounds & shortness of breathing, prolonged expiration, cyanosis, manifestations of corpulmonale (right ventricle failure) 3. Emphysema: Barrel shaped chest, flate cliaphargm dialated lungs, dyspnoea, tachypnea. Diagnosis of COPD: 1. Chest X-ray 2. Sputbm test 3. Pulmonary function test 4. ECG 5. ABG 6. Blood investigations 7. Health history with clinical assessment Management of COPD Tell the patient to avoid the smoking. Oxygen should be administered as early as possible. Brancho-dialators should be use. Amino phylline Deri phylline Medical Surgical Nursing –II Antibiotics should be given Directors can be given. Anti inflammatory drugs should be use. Surgical Management Ballectomy : Bullvectomy is the procedure in which areas with the air are remove by thoracotomy. LURS: Long volume reduction surgery. Nursing Management: Nursing diagnosis Ineffective airway R/T obstruction in bronchial tree. Goal : Patient will have effective airway. Interventions: Proper position Suctioning Tracheostomy core 2. Impaired breathing pattern R/T disease process Goal: Patient should have sufficient breathing pattern. Intervention: Administer oxygen by using bag and mask. Administer branch dilators. 3. Altered nutrition less then body requirement R/T reduce appetite. Goal: patient should have normal body weight. Intervention: Advise the patient to have small frequent feed Advise the patient to avoid gas producing food Give intravenous vitamins 4. Anxiety R/T disease process Goal: Patient have reduce anxiety. 51 52 Intervention: Tell him about treatment process Provide calumn environment to the patient. If necessary anti anxiety drug may be given. 5. Risk of infection R/T surgery Patient should have reduce chonees of infection Intervention: Maintain proper isolation technique proper worked core should be done. 6. Knowledge deficit R/T disease process Goal : Provide Health Education Intervention: Maintain personal hygiene Maintain skin integrity Provide knowledge about disease, causes, sign, symptoms and treatment Q.2 Define pneumonia, write down causes, signs and symptoms and management? Ans. Inflammation with consolidation of long tissues is known as pneumonia: Etiology: Bacterial – pneumococcus, streptococcus. Chicken poxvirus Fungal pneurmonia – cry ptococcosis Aspiration of fluids Risk factor: Malnutrition Immuno suppression Medical Surgical Nursing –II 53 Chonic smokers Infections Classification 1. Labor pneumonia: In labour pneumonia one or more lobes are affected. It is commonly caused by pneumococcus. 2. Brocho – pneumonia : In broncho – pneumonia there are various patchy area one from. It is common caused by streptococcus. 3. Aspiration pneumonia :- It is caused by Ingestic of vamits, amniotie fluids, water. Clinical manifestation: Cough with sputum, chest pain feverwith chills, dyspnoea, grunting. Diagnosis of pneumonia Chest – X- Ray Investigation of sputum Blood instigation Auscultation duall sound Unequal chest expansion during inspiration Management: Antibiotics are given Penicilline Amoxyciline Gentamycin Antipyretics – Paraeetamol and neumoslicle Analgesic – Diclofenee Bronechodialators Nursing Management 1. In effective airway – proper position, sectioning, andotraehial ineusation. 54 2. Breathing in sufficiency : - Proper position, oxygen administration by using mask and bag. 3. Prevention of from infection. 4. Skin care – to prevent badores 5. Reducing the anxiety by using psycho-emotional 6. Provide health education R/T personal hygiene. Q.3 Define long abscess? Write the management of such case? Ans. Long abscess is a condition in wh ich collection of pas with in the long tissue There are two type of long abscess: 1. Single long abscess 2. Multiple long abscess Actiology : 1. Unaerobic bacteria saehas staphylococcus 2. Bronchial obstruction due to mucus plagging. 3. Aspiration of various materials such as vomits, amniotic 4. Various surgical procedure 5. Various traumatic injuries may also lead long abscess. Clinical Manifestations 1. Fever with chills 2. Cough with sputum 3. Dyspnoea 4. Cyanosis 5. Haemoptysis Diagnosis 1. Physical examination Medical Surgical Nursing –II 55 2. Chest X-ray reveals pus formation and shows charities so the appearance is seen like a honey cons. 3. Sputum examination reveals the nature of infection 4. CT scon 5. ABG analysis Management Oxygen administration to prevent dispnoees, hypoxemia and maintain proper tissue perfusion. Antibiotic theraphy : The antibiotic theraphy should be continue for a lony time. Chest physiotherapy and patient drainage should be done by proper techniques. Cough expectorant may be use in case of cough. Antipyretics may also be prescribed to reduce the fever. Q.5 Define pnecomothorax? Ans. pnecomothorax is the accumulation of air in the pleural spa there are following types of pneinotherus 1. Open pnecomothorax: When air enters through open chest wound or incision then it is known as open pnecomothorax 2. Close pnecomothorax : When air accumulates in the pleural space through hole in the internal respiratory structures. 3. Tension pnecomotherax: Tansion pnecomothorax is a con. in which the air accumulated in pleural spacue is not expelled out by which the pressure or tension on media stinal contents increase which may lead depr. Of heart causes decreased cardiac output. 56 Unit XIII Nursing management of patients with digestive and Gastro intestinal disorders Q.1 Define peptic wear. Write down dictary and nursing management? Ans. Peptic weer disease involve the discontinuity of muces: membrane in the oesophages, gastric, and duodenal part basically it is caused by excessive secretion of HCI and pepsi. Etilogy: 1. Increase or chronic intake of aspirin, NSAI and anti inflammatory drugs, alcohol may damage the mucas memsrone. 2. Zollinger – Elision syndrome : The abnormal secretion hormone gastrin is known as zollinger- elision syndrome 3. Stess: pepticuleer is psycho-somatic disorder 4. Spicy foods Clinical Manifestation: 1. Pain: Pain will be felt in the right epigastric region 2. Nausea and vomiting – Patient with gastric weer have decrease appetite and diet. 3. Bleeding 4. General weakness 5. Burning sensation in the epigestrium region. 6. Burning sensation in the epigestrium region. Medical Surgical Nursing –II 57 Investigation: 1. CBS 2. Stool examination 3. Endoscopy 4. EGD oesophago gastro dhodenoscopy – This procedure is similar as endoscopy but by this we can also take biopsy of the lesion. Management: 1. Medical management Anti microbial drugs H2 blockers Antacids and antisecretory drugs are given. 2. Surgical Management Vagotomy: Vagotomy is a procedure by which that the acid secreting cell are eliminated by cating the fibres of vagous nerve. Heterprobe cautenzation: It is a procedure by which the active bleeding site is cauterized by using electric current on the affected tissue. 3. Nursing Management Control the fluid volume deficit Control the pain (Epigestre pain) Maintain the adequate nutrition level Control the diarrhea Assist in general are of the patient. 4. Dietary Management: Avoid spicy and only foods Avoid alcohol, excessive tea, and coffe Diet should be in small and frequent meals 58 Q.2 Write down sign and symptoms etiology and management of gastritis? Ans. It is on inflammation of the gastric maeosa. It is two types 1. Acute gastritis 2. Chronic gastritis Etiology: 1. None steroidal anti inflammatory drug 2. Steroids 3. Chemotherapeutic agent 4. Coff, tea, excessive oil and spicy food. 5. Alcoholism 6. Food poisoning Sign and symptoms: Eprigastric pain, tenderness, malaise Belching (expulsion of stomach air from mouth and nose) Regurgitation Nausea, vomiting Anorexia Weakness Burning sensation in the epigastric region. Clinical Diagnosis Investigation of gastric contents Endoscopy EGD (oesophage – gastro - duodenoscopy) Blood investigations Complete history of dictory habits Management Antacids Omeprazole Medical Surgical Nursing –II 59 H+ inhibitors – ranitidine 4. In case of non steroidal anti inflammatory drug (NSAID) ingestion of PGE (Prostaglandin E) should be given. 5. Symptomatic drug may also be give Domperidon Metrogyl 6. Provide health education relation to personal hygiene Q.3 Define intestinal obstruction, it's sign and symptom and nursing management Ans. Intestinal obstruction is a condition in which forward flow of intestine contents is impair partially or completely. Incidence: 90% of intestinal obstruction occurs in small intest. Intestinal obstruction is a surgical emergency and show be treated with in 24 hrs. otherwise it may lead death also. Clinical manifestations: 1. Temperature, normal but high pulse rate 2. Nausea and vomiting 3. Electrolyte imbalance 4. Abdominal pain in cramps 5. Tenderness 6. Peristaltic wave are visible on abdominal distention 7. Respiratory distress due to pressure on diaphragm. 8. Dehydration 9. Weakness and dryness Clinical Diagnosis 1. X-ray – Barium X- ray shows site of perforation and obstruction 60 2. Blood investigation 3. Electrolyte estimation Management 1. Removal of fluid by using intestinal tube. 2. Decompression – Decompression in a procedure in which. The abdominal contents are decompressed by using CO2 or other gasic to se the clear picture of obstructed part then after surgical removal of that part may also be performed. Nursing Management: 1. Administer prescribed analgesics 2. To relieve air fluid lock syndrome turn the patient from sup to prone position every 10 minutes. 3. Measure and record all intake and output. 4. Administer IV fluids. 5. Monitor vital signs 6. Save all stools to test for occult blood. 7. Record amount and consistency of stools. 8. Keep the patient in fowler position to promote ventilation and relive abdominal distention. 9. Detect early signs of peritonitis, suchas rightly and tenderness 10. Avoid enemas 11. Observe for signs of shock – pallor, tachycardia, hypotension 12. Provide psychological support, offer counseling , if desired. Q.4 What is jaundice? Describe the signs/symptoms, treatment and nursing management? Ans. Jaundice the yellow discoloration of skin and mucus membrane due to excessive accommodation of bilirusin in the blood. Normal tatal bilirusin level = 0.1 – 1.0 mg % Medical Surgical Nursing –II 61 Direct bilirusin leval or conjugated = 0.1 – 0.3 mg % Indirect bilirasin level or unconjugated = 0.2 – 0.8 mg % Un conjugated hyperbilirubinemia : It occurs out side the liver. In which unconjugated bilirabin level decrease in the blood due to haemotysis. Conjugated: Conjugated hyperbilirusin may result from impaired expression of bilirasin from the liver due to hepato celluler disease. Obstructive Jaindice: It is also known as biliary obstruction it occurs due to gali stone in the extra hepatie dvet. Sign and symptoms: 1. Yellow sclera and nucas membrane and skin 2. Yellow colored urine 3. Fatigue 4. Anorexia 5. Abdominal pain 6. Nausea and vomiting 7. Weight loss 8. Headache, fever, chills in case of infection Clinical diagnosis 1. Liver diagnosis 2. Blood investigation 3. Electrolyte estimation Management: 1. Removal of fluid by using intestinal tube. 62 2. Decompression – decompression is a procedure in which the abdominal contents are decompressed by using CO2 or other gasic the see the clear picture of obstructed part then after surgical removal of that part may also be performed. Nursing Management 1. Administer prescribed analgesics 2. To relieve air fluid lock syndrome turn the patient from sup. To prone position every 10 minutes. 3. Measures and record all intake and output 4. Administer IV fluids 5. Monitor vital signs 6. Save all stools to test for occult blood. 7. Record amount and consistency of stools. 8. Keep the patient in fowler position to promote ventilation and relive abdominal dictation. 9. Detect early signs of peritonitis such as rightly and tendering 10. Aviod enemas 11. Observe for signs of shock pallor, tachycardia, hypotension 12. Provide psychological support, after counseling, if desired. Medical Management A complete history of the patient should be taken and determine the real cause of jaundice Anit histamine should be givento relieve itching. It skin lesions develop and become infected than antibiotics should be given. Symptomatic drugs should be given for fatigue, fever and weakness Nursing Management Provide comfortable position to the patient to prevent to bed. Maintain the fluid and electrolyte balance Medical Surgical Nursing –II 63 Provide the drugs according doctors order Maintain the intake and out put chart. Provide the psychological support to the patient. Patient feel anxiety than provide the antianxietie durgs. Prepare the patient for surgical procedure. Provide health education about personal hygiene, rest, diet active and passive exercise and medication etc. Q.5 Define hepatitis with management? Ans. Hepatitis is the inflammation of liver. Hepatitis may be viral, toxic and alcoholic hepatitis. 1. Hep. A : It is caused by hep. A virus. The cause of epidemics are infected water, milk, food. It spread through faelo-oral route. 2. Hep.B- It occurs world wide. It occurs in multiple blood transfusion, homosexual ……..people who …………….. 3. People who under going and drugs users. 4. The virus also found in saliva and semer, so parental sexual intercourse and liplock kissing are major route of the transmission. 5. Incubation period – 30 120 days. Clinical Features : 1. Pain in the right hypochondric region mainly but is may radiate in the other regions of abdomen. 2. Anorexia, nausea and vomiting 3. Abdominal pain is also caused by stretching of glissions capsule surrounding the liver the to the inflammation 4. Fever 5. Fatigue and malase 6. Dark urine and stool 7. Muscles termers chue to encephalopathy 64 8. Bleeding tendency 9. Heputomegaly 10. Hypergly caemia Management: Bed rest should be given to minimize the daily activities. Low fat and balance carbohydrate diet should be given to the patient. When the patient is unable to take orally them IV fluid should be given. Alcohol should be restricted Antiemetic should be given for nausea and vomiting Paentral vitamin K should be given. Good personal hygiene should be maintained. Proper screening of sex workers, prostitution, call girls and home sexual is necessary. Screening of donor blood for HBC Ag and HBS Ag antibodies Proper sterilization of artides Safe disposable hospital waste should be maintained Q.6 What is cirrhosis liver? Explain the management in details? Ans. Cirrhosis of the liver is characterized by scarring. It is a chronic disease. Due to inflammation the fibrosis and nodules are character bed. Most common cirrhosis due to chronic alcoholism and malnutrition. Clinical manifestation: Onset is insiders may take years to develop Early complaints include fatigue, anorexi Edema of the onkles in the evening Epistaxis and bleeding glems Weight loss Medical Surgical Nursing –II 65 Chronic dyspepsia Constipation or diarrhoea Splenomegaly Amemia, weakness Depression Diagnosis Evaluation : Liver biopsy Liver scan shows abnomed thickening and liver mass Parenthesis Laproscopy Liver friction test Management: Minimize further determination of liver foretion through the withdrawal or toxic substances, alcohol and drugs. Correction of nutritional deficiencies with vitamins. Treatment of ascites and fluid and electrolyte imbalance. Bed rest to aid in divers is Abdominal peracentesis is done Symptomatic relief measures such as pain medication and automatics. Encourage and assist with gradually increasing periods of exercise. Suggest small frequent feeding Encourage oral hygiene before meals. Administer or teach self administration of medication for nausea, vomiting diarrhea or constipation. Advise patient to keep fingernails short Observe stools and emesis for color, consistency and amount. Protect from sepsis intake and out put and seram electrolyte level to prevent dehydration. 66 Assess level of consciousness Provide psychological support to the patient. Provide the knowledge about the disease process. Medical Surgical Nursing –II 67 Unit XIV Nursing management of patients with metabolic and endocrine disorder Q.1 What do you under stand by diabetes mellitus? And explain the nursing management in details? Ans. Diasetes mellitus is a metabolic disorder characterized by hyperglycemia and results from defective insulin production secretion or utilization. Path physiology/Etilogy 1. Absolute or relative lack of insulin produced by the beta cell resulting in hyper glycemia – There are two types of diabetes mellitus a. NIDDM: Impaired secretary response of insulin to rises in glucose b. IDDM: Viral autoimmune and environment Heredity/genetics and abesity play a major role. Clinical manifestation: [A] Hyperglycemia – Weight loss, fatigue – Polyuria, poly dipsia, poly phagia – Blurred vision [B] Altered tissue response – Poor wound healing Recurrent infections, particularly of the skin. 68 Diagnosis evaluation 1. Random, fasting or 2 hour post prondial glucose test 2. Glucose Folerence Test (GFT) Management 1. Dict: Dietary control with coloric restriction of corbohych and saturated fak to maintain ideal body weight. – The goal of meal planning is to control blood glucose and lipid level. – Weight reduction is the primary treatment of diabetes mellitus. Exercise: Regularly scheduled exercise to promote the utilization of carbohydrates, assets with weight control enhance the action of insulin, and improve cardio vascular fitness. Medication: Oral hypoglycemic agent insulin therapy. – Preventing injury secondary to hypoglycemia – Improve activity tolerance – Maintain skin integrity – Improve coping strategies – Provide knowledge to the patient about survival skills, lifestyle management skills. Q.2 Write short notes on hyperthyroidism? Ans. This hyper metabolic condition is characterized by excursive amounts of thyroid hormone in the blood stream Etiology: 1. Over functioning of entire gland 2. Toxic malfinodular goiter 3. Emotional upset Medical Surgical Nursing –II 4. Worry, over work anxiety 5. Acute infection Sign and symptoms 1. Nervousness, emotional liability, irritability 2. Difficulty in sitting quietly 3. Rapid pulse rate as well as on exertion, palpitations 4. Profuse perspiration 5. Increases appetite and progressive weight loss 6. Weakness omenorrhoea 7. Bulging eyes 8. Phyroid gland may be pulpable and a bruit may be abscultated over gland 9. Delirium, disorientation 10. Fever, dehydration, hypertension, dysonoea Management 1. Antithyroid medicines – methamazole 2. Radio – Iodine therapy – for middle age. 3. (beta) adrenergic blockers – Subtotal thyroideetomy or total thyroideetomy – Monitor the cardiac rate and rhythm continuous. – Maintain the adequate cardiovascular function – Maintain the fluid and electrolyte balance – Maintain supportive nursing care, (personal hygiene) – Provide comfort – Provide psychological support – Provide knowledge about disease causes complications and treatment 69 70 Q.3 Write short notes on diabetic ketoacidosis? Ans Diabetic ketoacidosis (DKA) is an acute amplication of diabetes mellitus characterized by hyperglycemia, ketonuria, acidosis, and dehydration Clinical Manifestation Early : Polydipsia, polyuria Fatigive, malaise, drowsiness Anorexia, nausea, vomiting Abdoninal pain, muscles cromps Later: Deep respiration (Kussmanl respiration) Fraity sweet breath Hypotension and weak pulse Stupor and coma Management : 1. IV flick 2. IV insulindrip 3. Electrolyte replacement 4. Provide comfort to the patient 5. Improve personal hygiene 6. Prevent the patient form infection 7. Maintenance body temperature 8. Provide psychological support 9. Provide the knowledge about the disease process and treatment Medical Surgical Nursing –II 71 Unit XV Nursing Management of Patients with Rural and Unary Disorder Q.1 What is acute renal failure? Describe is etiology, sign and symptoms treatment and nursing management? Ans. Acute renal failure is a syndrome of verging causation that results in a sudden decline in renal function. Causes : 1. Prerenal cause: Result from condition that decrease renal blood flow. 2. Postrenal causes: Arises from obstruction to urine flow anywhere along the urinary fract. 3. Intracranial causes: Result from injury to renal tissue and is usually associated with intracranial is chemia, tosins, immbnology process. Clinical menifestations 1. Prerenal: Decreased tissue turgor, dryness of mucus mem. Weight loss, hypotension, aliguria, or anuria. 2. Postrenal: Difficulty in voiding charge in urine flow. 3. Intrarenal: Fever, skin rash, edema. Diagnostic evaluation: Urinalysis: Reveals & protenuria, haemauria Rising serum creatinine and BUN level Urine chemistry examination Renal ultra sonography 72 Management: Corrective/supportive measures: Correct any reversible cause of acute renal failure. Be alert for an correct underlying fluid excess or deficits. Correct and control biochemical imbalances Restore/maintain blood pressure Maintain natritein Initiate hemodialysis, peritonent dialysis or continuous ronal replacement therapy for patient with progressive azotemia . Nursing Management Identify patients with pre existing renal disease Initiate adequate hydration before, during and after operative procedures. Avoid expose to various nephrotoxins Avoid exposure to various neurotoxins Avoid chronic analgesic drug – causes interstitial nephritis and papillary neerosis. Prevent and treat shock with blood and fluid replacement Prevent prolonged periods of hypotension Monitor urinary output. Pay special attention to draining wounds, burns etc which can lead to dehydration and sepsis and progressive renal damage Avoid infection Take every precaution to ensure that the right person receive the right blood. Maintaining adequate nutrition. After high – carbohydrate feedings Prepare for dialysis which may help prevent mueologic complications. Provide health education about persent hygiene, disease process treat. Medical Surgical Nursing –II 73 Q.2 Define renal stones, etiology sign and symptoms and management in detail? Ans. Nephralithiasis refers to renal stone disease stones and calcite are formed in the urinary treat from the kidney to bladder by the crystallization of substance excreted in the urine. The majority of stones (60%) are composed of calcium oxalate crystals. Etilogy : The precipitating factors are : 1. Increased soluble concentration of calcium oxalate, cystein, phosphate, peurin. 2. Reduced amount of inhibitions. 3. Alfered PH of urine. 4. Prolong stonding, dehydration, reduced fluid intake. 5. Excessive exercise 6. Increase close of vitamin C 7. Some medications also cause stone – folic acid and calcium carbo 8. Inflammatory bowal disease 9. Hereditary – xonthire store Clinical diagnosis 1. IVP = Intra venous pyelography 2. KUB (Kidney ureter, Bladder) X- Ray 3. Urine analysis for hoemalumia, pyaress PH Clinical Features: 1. Pain 2. Obstruction of urine – painful maturation 3. Inflammatory symptoms – fever, vomiting nausea, chills 4. Anorexia, Abdominal discomfort 5. Hypothermia – Mild shock 74 Management: Medication: 1. Alopurinal 2. D-Penicillomine 3. Antibiotics Dietary Management Avoid milk and milky product Use green leafy vegetables Avoid coffee tea cabbage, brinjal tomato , citous food Use acidic food – meat, fish ego, chocolate Surgical Management PCNL – Percutoneous nephralithtomy Open surgery : - Cystolithotomy, Nephrecotomy Nursing Management 1. To relieve pain Assess the site and nature and pain Provide suitable position Provide analgesic as doctors order prescription 2. To maintain urine flow Maintain fluid and electrolyte balance Maintain intake and out put chart. 3. To prevent from infection Administer antibiotics Maintain personal hygiene Use aseptic techniques in every process 4. To maintain fluid volume 5. To provide knowledge knowledge about, diseae, complication, treatment exercise, diet and personal hygiene Medical Surgical Nursing –II Q.3 Write short notes on bacterial pyalonephrits? Ans. Inflammation of renal pelvis and renal porencyma that is called pyelenephrits. 75 Causes: Bacteria: E – Cali, coronary distraction infectin trauma, pregnancy, metasalic disorders, diabetes mellite Clinical Feature: Fever with chills, flank, pain, tenderness, nausea, vomiting, headeale, muscular, pain Diagnosis: Urine test. Management : Provide symptomatic treatment as prescribed by the doctor. Provide antibiotics for bacterial infection. Maintain fluid volume Provide the general core Provide nutritional diet Maintain nutritional hygiene Assist in activities of daily living (ADL) Provide comfortable position Provide knowledge about continuous treatment, tests and personal hygiene Provide psychological support Q.4 Define and stage renal disease (ESRD). It sign and symptoms and management in details? Ans. ESRD is also called CRF. Chronic renal failure is a progress detoriation of renal function. Which ends fatally in uremia for it complication unless dialysis or a kidney transplant is perform 76 Etilogy: Hyprtension – Prolonged and sever Diasetes mellitus Glomeralo nephritis Hereditary renal disease Obstructive uropathy Development/congenital disorder Clinical manifestation: 1. Gastrointestinal : Anorexia, nausea, vomiting 2. Cordiovascular: Hyperkalemic ECG changes, hypertension, pericorditis 3. Respiratory : Pulmonary edema, plural effusion 4. Neuro muscular : Fatigue, sleep disorder head aahe, lethargy seizures, coma 5. Metabolic oral endocrine : Glucose intalerenee, sex hormone distrasene causing decreased libido. 6. Fluid electrolyte acid base disturbance 7. Dermatologic: Pallor praritus 8. Haematologic: Anemia, defect in quality of platelets 9. Psychosocial functions: Personality and behavior changes. Diagnostic evaluation: 1. Complete blood fount (CBC) 2. Elevated serum keratinize, BUN, phosphorus 3. Decreased serum calcium 4. ABG – Lowblood PH, low CO2 bicorbonate (HCO3) Management 1. Detection and treatment of reversible couses renal failure 2. Dietary regulation Medical Surgical Nursing –II 77 3. Treatment of associated conditions to improve renal dynamics Amemia Acidosis Hyperkalemia Phosphate Retention Complication Death Nursing Management Maintaining fluid and electrolyte balance Maintaining adequate nutritional status. Maintaining skin integrity Administer drugs for relief of itching of indicated Encourage high fiber diet, braining in mind the potassium content of some frank and vegetables. Increase activity as federated Administer medications as ordered : Phosphate binding medication such as aluminum hydroxid or calcium carbonate Calcium supplements between meals to increase serum calci Vitamin D increase desorption and utilization to calcium Prepare patient for dialysis or kidney transplantation Discuss option of supporting psychotherapy for depression Provide for sefl care Promote decision making by the patient Refer patient and family members to renal support agencies Provide knowledge regarding weight self every morning to avoid fluid over load Drink limited amounts aonly when thirsty Eat food before drinking fluids to alleviate dry mouth. 78 Unit XVI Nursing Management of Patients with Neurological Disorders Q.1 Define head injury with sing and symptoms and nursing management? Ans. Head injury also known as brain injury is the disruption of normal brain function due to trauma related injury resulting in compromised neurologic factions. Types of brain injuries include concession, cerebral contusion brain stem contusion, epidural hematomo, and skill fructure. Caused by blant or penetrating injury. Clinical Features Disturbance in consciousness confusion to coma Headache, vertigo Rest lessness Respiratory irregularities Cognitive deficits Sudden onset of neurologic deficit Diagnosis Evolution CT scanning of head Skill and cervical spine film EEG Neurologic assessment Medical Surgical Nursing –II Management : Management of increased ICP Antibiotics to prevent infection Surgery for evacuation of intro cranial hematoma Complication 1. Infection 2. Increased ICP 3. Service disorder Nursing management 1. Maintain adequate cerebral perfusion Maintain a patient Airway Monitor ICP Administer IV solutions slowly to avoid over dehydration and edg. 2. Maintaining respiration Monitor respiratory rate, depth, and pattern of respiration Assist with intubation of needed Suctino patient as needed. 3. Meeting nutritional status (needs) Provide nasogastric feedings Administer IV hyper alimentation as ordered 4. Promoting cognitive function Provide stimulation of all sensory avenues Involve family in sensory stimulation program Provide frequent concern orientation information 5. Preventing injury Instruct the family regarding the behavioural phases of recovery from brain injury. Such as restlessness and combative Provide passive mation exercise 79 80 6. Strengthening family coping Provide psychological support help the family assist the patient to recognize current progress Educate the family members about disease progress Q.2 Define meningitis and it's management? Ans. Meningitis is the inflammation of the meanings or membrane living the brain and spinal cord. Usually secondary to other bacterial infection such as sinusitis, eitis media, pnecmenia, endocarditis. Common bacterial organism neisseria meningitis (meninge coccal meningits) Clinical manifestation: Headlache, baekaehe, fever, leuckeytosis, changes in patient mental status photophosia, nuchal rigidity. Diagnostic evaluation CBC, blood calture, CSF culture, MRI, CT scan. Management Antibiotics, steroids , and osmotic dibretics to reduce cerebral edema. 1. Reducing fever Provide antipyretics and monitor temperature frequently 2. Maintaining fluid balance Administer IV fluids, monitor intake and out put chart. 3. Assess level of consciousness vital sign Maintain quiet and calm environment 4. Reducing pain Administer analgesic Medical Surgical Nursing –II 81 Daken the room if photophobia is present 5. Patient education Encourage the patient to follow medication Encourage follow up and prompt attention to infection in facture. Q.3 Define encephalitis, it's clinical manifestation and treatment? Ans. Encephalitis is the inflammation of cerelrit tissue caused by on infection agent or other toxin. A virusa, including rasio virus, the enter virus and the harpes virus are common inteetious agent. Clinical manifestation: Fever, headache, meaning sign nasusea and vomiting, confusion, seizure etc. Diagnostic evaluation : CSF. CT Scan, MRI, EEG Treatment Acylovir (xovirax) given IV if caused by herpes simiplex virus Anti conversant to prevent and treat seizures Sedatives and analgesics Supportive core Maintain quiet eminoment and provide are gently. Maintain seizure precautions with side rails padded. Monitor neurologic status closely, watch for subtle changes such as behavior or personality changes, wealness. Monitor temperature and vital sign frequently Administer antipyretics Monitor intake and out put charting Monitor for other complication such as comes, frequently fatal, orinary freat infection and pneumonia. Explain the effects of the disease process and treatment Encourage follow up for evaluation of deficits and rehabilitation potential. 82 Q.4 Define seizures and explain treatment in detailed? Ans. Seizures close know as epileptic seizures and, if recurrent emilepsy are thought to result form disturbances in the cell of the brain that cause than to give off abnormal, recurrent controlled electrical discharges. Causes: Idiopathic Hypoxemia Vascular Insufficiency Fever Head injury Hypertension Infection of a Metasalic changes Bran tomour Drug withdraw Clinical Manifestation: 1. Impaired consciousness 2. Excess or loss of muscles tone or movement 3. Disturbance of behaviour, mood sensation and perception 4. Disturbance of the automatic fanetions of the body. Diagnostic Evaluation: 1. ECG with or without video monitoring 2. MRI or CT scan to identify lesion that may be cause of seizure. 3. Neuro physiological studies – to evaluate for behavior changes Medical Surgical Nursing –II 83 Treatment : Pharmacotherapy drug selected according seizure to Carbamazepine, phonation, Phenobarbital Surgical correction of effected of brain Nursing intervention : Ensuring on adequate airway Protecting the patient from injury To maintain tissue perfusion to occurrence of seizers To reduce the stress Provide psychological support Educate the patient and patient's relatives about disease Q.5 Define Parkinson's disease and explain its mono. Ans. Parkinson's disease is a progressive neurologic disease affecting the brain contents responsible for the control and regulation of movement. Risk factor : Altherosderosis of muscles; Arterial hyper tension, diabetes hyper lipidemia Clinical Menifastation: Tremor, rigidity, akinesia (loss of muscles function) Automatic disorder – sleeplessness salivation, suieating Depression, psychiatric distransences, dementia etc. Management: Anticholinergics drugs, amentadine, levodopa, bromociptine etc. Combination drug therapy and rehabilitation techniques Maintain reparation 84 Improve mobility and functioning of patient. Encourage the patient for self core. Maintain input and out put charting. Prevent from any type of complication and injury Provide adequate nutrition diet. Provide health education regarding disease causes about procedure during core, treatment of disease. Medical Surgical Nursing –II 85 Unit XVII Nursing Management of Patient with Disorders of Connective Tissue and Collagen disorder Q.1 Define rheumatoid arthritis and it's clinical manifestation? Ans. Rheumatoid arthritis is a general term used to describe what may be a heterogeneous of inflammatory disease affecting both joints and other organ systems. Etiology : 1. Immunologic process result in inflammation of synovial producing antigens and inflammatory by products ederra and production of a granular tissue called panes. 2. The etiology & unknown but is probably a combined effect of environmental, demographic infections and genetic factors. Clinical Manifestation: 1. Arthritis 2. Skin manifestations Rheumatoid modules, elbow & occipal, sacrum 3. Cardiac manifestations Acute pericorditis Conduction defects Cormory orteritis 4. Pulmonary manifestations 86 Pleural effusion Asymptomatic pulmonary disease Laryngeal obstruction 5. Neurologic manifestations – Corpal tannel, syndrome Wrist drop, foot droop 6. Systemic manifestations Fever Faitgue Weight loss Q.2 Explain the management of rheumatoid authritis? Ans. Pharmacologic NSAIDS Corticosteroids – to reduce inflammatory process Local comfort measures Application of heat oral cold Use splints No pharmacologic modalities Behavior modification Relaxation techniques Surgery Synovectomy Arthrodesis – Joint fusion Total joint Replacement Nursing diagnosis 1. Chronic pain related to disease process 2. Impaired physical mobility related to pain and limited joint motion. 3. Self care deficit related to & llimitations. Medical Surgical Nursing –II 87 4. In effective individual coping related to pain physical limitations. Nursing interventions Controlling pain Optimizing mosicity Promoting self core. Strengthening copying Instract patient and fomily in the nature of disease Education about pharmacological agents. Medication must be taken consistently to achieve maximum benefit. Reinforce to patient the need for life long fragment. Q.3 Define gout and patient classification? Ans. Government is a disorder of purine metabolism characterized by elevated uvic acid and deposition of urate in joints and other tissues. Pathophysialogy Government results from on overasumdent accumatation and subsequent deposition of uric acid in the body this can occur in one of two ways. 1. Over production of uric acid (10% of cases) 2. Certain disease conditions 3. Lymphopraliferative disorders 4. Cancer chemotherapy 5. Hemolytic onemias 6. Psoriasis 2. Under excretion of uric acid (90% of cases) 88 Renal disease endocrime disorder medications Clinical features/classification (A) Acute govty arthritis Generally affects one joint often the first metatorso phalange joint called podagra. Other joints can be affected such as on fasals, knee. Pain, wormth, crythema and swelling of tissue surrounding the affected joint Fever may occur Onset of symptoms is sudden, intensity serve. (B) Chronic to apiaceous goat Occurs if acute goat is inadequately treaty or goes antreated. Characterized by development of tophi or deposits of uric acid in and around joints cartilage and soft tissue. Arthritis is more chromic in nature with disease atlocks less common. (C) Renal disease Caused by hyperuricemia (persistent elevation of uric acid in the blood) Kidney stones are composed of uric acid deposition of uric acid in kidney tissue. Q.4 Explain the management of government in detail? Ans: (A) Pharmacologic NSAIDS for acute attacks to relieve pain and swelling Corticosterocls: Intra articulor if attack combined to one joint. (B) Urate – lowing agents: Uricosuric drugs such as probe acid (benamid) inter fere with tubular reasorption of uric acid. Allopurine – interferes with conversion of hypes xonthine and xonthine to uric acid. Medical Surgical Nursing –II 89 (D) Non pharmacologic Avoidance of obesity Aviodenceof alcohol Low purine diet gives only a minor decrease in serum aric acid level. Nursing diagram Pain related to acute arthritis Impaired physical mobility related arthritis. Nursing Implantation Relieving pain – administer and teach self administration of pain relieving medications as prescribed. Encourage adequate fluid intake to assist with exertion of uric and decrease likelihood of stone formation Facilitation mobility assist in activities of of daily Encourage exercise and maintenance of routine activity in chronic government, except during acute attacks. Encourage to avoid alcohol. Avoid medications known to increase uric acid levels. Instruct in sign and symptoms of allopourinol hyper sensitivity syndrome and need to report promptly. Educate the patient about personal hyofiere, balance diet, exercise and treatment. Q.5 Define psoriatic arthritis with clinical manifestations? Ans. Psoriatic arthritis is on inflammatory arthritis that can be seen in patient with psoriatic skin disease or psoriatic nail disease. 90 Pathphysiology: Disease manifestation is probably on interaction among immane, genetic, and emission mental factor. Clinical manifestation: Inflammatory arthritis Asymmetric arthritis involving a few joints – tips, knees, onkles, and unit. Spinal arthritis – approximately 20% to 40% of patients Skin imaheement : Pboriasis may be mild or severe Arthritis may precede the development of skin disease. Nail disease is present in the large majority to patients with proratic arthritis Extra orticular – menifestations Eye inflammation – conjunctivitis Pulmonary fibrosis Aortic insufficiency Diagnosis evaluation CBC ESR Synovial fluid analysis X-ray Skin Biopsy shown choroetersite hhper keratosis and other changes Medical Surgical Nursing –II 91 Unit XVIII Nursing management of the Elderly Q.1 Define Gerontological nursing or aging process ? Ans. Growing old (aged) is an inevitable process in every one life. The persons above 65 years are considered as aged. As we grow old, the health needs also very. Geriatrics is the branch of medicine dealing with the problem of the ageing and the disease of the elderly. An important part of the aged to live happy and to their satisfaction. The ageing process is complex. The body continuously replaces the worm out cells & all through the life of the individual. As years pass, the rate of replacement slows down. This the functions of the each system of the body is impaired and give rise to disorders. The process of aging may also hastened by environment, disease, emotional stress fautly life styles malnutrition etc. Q.2 What are the common health problems in older adults? Ans: Common health problems are: 1. Cardio vascular disease – hypertension ischemic heart disease, heat failure, dehydration, storke. 2. Neurologic: Parkinsonism, alzeimer's disease or dementia depression, psychosis, sleep disturbance, subdural hematoma 3. Respiratory: COPD, dysnnea, pneumonia 4. GIT: Constitution dearrhoea hernia, dysphagia anorexia 5. Genitourinary: Renal insufficiency urinary maintenance UTI, enlarged prostate, sexual syfunetion 6. Endocrine: Din, Gout, hyper or hypothyroidism 7. Musculoskeltal : Osteopoross osteomalacia, osteotrthritis fractures. 8. Arthritis may proceed the development of skin disease. 92 9. Nail disease present in the large majority of patients with psoniatic arthritis Extra articular- manifestations 1. Eye inflammation – conanetivitis 2. Pulmonory filonsis 3. Aortic insufficiency Diagnostic Evaluation CBC ESR Synovial fluid analysis X-ray Skin biopsy shows choraetorsite hyper keratosis and other changes. Medical Surgical Nursing –II 93 Unit XIX Emergency Management Q.1 Define basic approach to emergency core? Ans. Emergency core can be defined as the episodic and crisis oriented are provided to patients with serious or potentially life threatening injuries or illness. The philosophy of emergency core includes the concept that can emergency is whatever the patient or family considers it to be. Q.2 Explain the emergency assessment with triage categories? Ans. A systematic approach to the assessment of on emergency patient is essential often. The most dramatic injury is not the most serious. The primary and secondary survey provide the emergency nurse with a methodical approach he help identity and prioritize patient needs. Airway does the patient have on open airway? Breathing is the patient breathing? Circulation – circulation in immediate jeopardy? [A] Is there a puse? [B] Is there profuse bleeding? Disability assess level of consciousness and pupils Assess level of consciousness using the AVPU scale. 1. A – Istle patient alert 2. V – Does the patient respond to voice? 3. P – Does the patient respond to painful stimules? 4. U – The patient is corresponsive even to painful stimules 94 Expose – undress the patient to look for clues to injury or illness, such as wounds or skin lesions. Reproductive : Female: Cenical cancer, breast cancer male: prostate cancer. Q.3 Explain the management of ageing process? Ans. Promoting self core and wellness in elderly Assessment : - Assess the cardiovascular staths Monitor the vital signs Observe for any complications Edema Dyspnea Chost pain Assess the visual and auditory activates. Assess the sign of cancer. Nursing diagnosis: 1. Self core deficit related to ageing process 2. Risk for injury 3. Altered nutrition 4. Alterations in visual and auditory activities 5. Social Isolation 6. Alfred tissue perfusion Nursing interventions Encourage the regular medical, dental, and visual examination Assess the living conditions to prevent for any injury Refer self help group Develop the new interest Medical Surgical Nursing –II 95 Assess the nutritional status Encourage for light exercise Educate the patient for elderly process and complication in elderly. Encourage for personal hygiene. Q.3 Explain the sign and symptoms with treatment end nursing core? Ans. Sign and symptoms Hot and dry flushed skin Pallor skin Body temperature more than 7,105 of Complaints of dizziness, nausea, and headaches Convulsing Altered level of consciousness Treatment and nursing core Maintain the temperature by hypo thermia blancket cold water baths, coolenemus Administer O2 to meet increase metabolic demands Institute seizures precautions Hypothermia Sing and symptoms Local : pallor, paresthesia, absence and sensation to involved body port Systemic : Body temperature < 94% wealc and irregular pulse, decreased level of consciousness Treatment and nursing core: Monitor the patient condition for any complications Assess the cardiac status 96 Maintain the electrolyte balance Arterial blood gases Blood, urea, nitrogen Use, warmer Correct fluid and electrolyte imbalance etc. Priorities of core/Triage categories Eonergent I: conflations requiring immediate medical intonation any delay in treatment is potentially life or lions threatening Includes conflations are Airway compromise Cardiac arrest Severe shock Cervical spinal injury Multisystem trauma Altered level of consciousness Eclompsia Urgent II ; Patient who present as stable but whose condition requires medical inter immediate threat to life or lins for these patients Conditions: Fever Minor burns Dizziness Laeerations Minor masculosketatal injury Nonemergent III : Medical Surgical Nursing –II 97 Patient who present with chronic or minor injuries. There is no donger to life or lims by having these patient wait to be seen. These patients are in no obvious distress. Condition are : Chronic low back pain Dental problems Missed menses Roatine medication refillis.