GNM THIRD YEAR MIDWIFERY AND GYNAECOLOGY JUNE 2019
MAHARASHTRA
NURSING COUNCIL, MUMBAI
EXAMINATION
IN GENERAL NURSING AND MIDWIFERY
THIRD YEAR
PAPER-I
MIDWIFERY
AND GYNAECOLOGY
TUESDAY, 25
JUNE 2019
Duration: 3 Hours Max.Marks:75
I. Select the
most appropriate words from the following and complete the statement: 1x5=5
(i) The normal rate of foetal heart sound
is............ per minute.
(α) 80-120
(b) 100-120 (c) 120-140 (d) 140-160.
(ii) After expulsion of placenta, control of bleeding
occurs due to ………
(a) Cervix
(b) Endometrium (c) Broad ligaments (d)
Living Ligatures.
(iii) ………. protects the foetus from infections through
pregnancy.
(a)
Internal O. S. (b) Opuricullum (c) Circular Muscal Fibers (d) External O. S.
(iv) When fertilized ovem embeded in anywhere other
than uterine cavity is called as ………
(a) Tubal
Mole (6) Ectopic Pregnancy (c) Vesicular Mole (d) Ovarian Cyst.
(v) Cu-t 380 is useful for............... years.
(a) 5 Years
(b) 8 Years (c) 10 Years (d) 12 Years.
(i) The normal rate of foetal heart sound is (d)
140-160 per minute.
(ii) After expulsion of the
placenta, control of bleeding occurs due to (d) Living Ligatures.
(iii) (b) Opuricullum
protects the foetus from infections through pregnancy.
(iv) When a fertilized ovum embeds
anywhere other than the uterine cavity, it is called (b) Ectopic Pregnancy.
(v) Cu-T 380 is useful for (c) 10
Years.
II.
Match the
following 1x5=5
'A' Group 'B'
Group
(i) Ruptured Uterus (a)
Mentovertical Diameter
(ii) Habitual Abortion (b) Folic Acid
(iii) Brow Presentation (c) Obstructed Labour
(iv) Megaloblastic Anaemia (d) Shirodkar Stitches.
(v) Neonatal Jaundice (e)
Death of Foetus.
(f)
Phototherapy.
'A' Group | 'B' Group
(i) Ruptured Uterus | (e) Death of Foetus
(ii) Habitual Abortion | (d) Shirodkar Stitches
(iii) Brow Presentation | (a) Mentovertical Diameter
(iv) Megaloblastic Anaemia | (b) Folic Acid
(v) Neonatal Jaundice | (f) Phototherapy
III.
State true
or false 1x5=5
(i)
Umbilical cord has two veins and one artery.
(ii)
Restitution is due to internal rotation of foetal head..
(iii)
Intake of any drug should be avoided during first trimester.
(iv)
Ultrasonography is harmful during pregnancy.
(v)
In placenta praevia placenta is implanted in upper segment of uterus.
(i) Umbilical cord has two veins and one
artery. False (The umbilical cord has one vein and two arteries.)
(ii) Restitution is due to internal
rotation of foetal head. False (Restitution is due to the realignment of
the foetal head with the shoulders after external rotation.)
(iii) Intake of any drug should be
avoided during the first trimester. True
(iv) Ultrasonography is harmful
during pregnancy. False (Ultrasonography is considered safe during pregnancy.)
(v) In placenta praevia, the
placenta is implanted in the upper segment of the uterus. False (In
placenta praevia, the placenta is implanted in the lower segment of the
uterus.)
IV.
Write short
notes on (any three) 3x5=15
(a) Partograph
(b) Functions of Placenta
(c) Care of Premature Baby
(d) Antenatal Advice
(e) Breast Feeding.
(a) Partograph
A partograph is a clinical tool used
to monitor the progress of labor and assess maternal and fetal well-being. It
includes:
- Labor Progression:
Tracks cervical dilation, descent of the fetal head, and uterine
contractions.
- Fetal Monitoring:
Records fetal heart rate, amniotic fluid color, and molding of the fetal
skull.
- Maternal Monitoring:
Tracks maternal pulse, blood pressure, temperature, and urine output.
The partograph helps identify deviations from normal labor, enabling timely interventions to prevent complications.
(b) Functions of
Placenta
The placenta performs several vital
roles during pregnancy, including:
- Nutritional Support:
Transports oxygen and nutrients from the mother to the fetus.
- Waste Removal:
Removes carbon dioxide and waste products from the fetus to the mother.
- Hormone Production:
Produces hormones such as hCG, progesterone, and estrogen to maintain
pregnancy.
- Immunity:
Transfers maternal antibodies to the fetus, providing passive immunity.
- Protection:
Acts as a barrier against certain infections and toxins, though not all
harmful substances are blocked.
(c) Care of Premature
Baby
Premature babies, born before 37
weeks, require special care to support their growth and development:
- Temperature Control:
Use of incubators or radiant warmers to maintain body temperature.
- Feeding Support:
Breast milk or specialized formula provided via tube feeding if sucking
reflex is underdeveloped.
- Monitoring:
Continuous monitoring of vital signs, including heart rate, breathing, and
oxygen levels.
- Infection Prevention:
Maintaining strict hygiene to reduce the risk of infections.
- Developmental Care:
Providing a quiet, low-stress environment to support neurological
development.
(d) Antenatal Advice
Antenatal advice aims to ensure a
healthy pregnancy and safe delivery. Key recommendations include:
- Balanced Diet:
A diet rich in iron, folic acid, calcium, and other nutrients.
- Regular Check-Ups:
Periodic visits to monitor maternal and fetal health.
- Exercise:
Light exercises, such as walking or prenatal yoga, to improve circulation
and reduce discomfort.
- Avoiding Harmful Substances: No smoking, alcohol, or use of harmful drugs.
- Awareness of Warning Signs: Educating about symptoms like bleeding, severe
headache, or reduced fetal movements.
(e) Breastfeeding
Breastfeeding provides numerous
benefits to both the baby and the mother:
- Nutritional Benefits:
Breast milk contains all essential nutrients, antibodies, and enzymes for
the baby's growth and immunity.
- Bonding:
Strengthens the emotional bond between mother and baby.
- Health Benefits for Baby: Reduces the risk of infections, allergies, and chronic
diseases.
- Health Benefits for Mother: Helps the uterus return to its normal size, reduces
postpartum bleeding, and lowers the risk of breast and ovarian cancers.
- Convenience and Cost:
Breast milk is always available and requires no preparation, making it
economical and convenient.
V.
Answer the
following questions 3x5=15
(a) Write the aims and objective of antenatal care
(b) What is the difference between fullterm and
preterm baby.
(c) Write the sign and symptoms of puerperal sepsis
(a) Aims and
Objectives of Antenatal Care:
- Ensure Maternal and Fetal Wellbeing: Monitor the health of the mother and the fetus to
detect and address any complications early.
- Promote Safe Pregnancy and Delivery: Provide guidance for a healthy pregnancy and prepare
for a safe delivery.
- Identify Risk Factors: Screen for high-risk pregnancies, such as
pre-eclampsia, diabetes, or anemia, and manage them appropriately.
- Health Education:
Educate the mother on nutrition, hygiene, breastfeeding, family planning,
and recognizing danger signs during pregnancy.
- Preventive Measures:
Administer vaccinations, such as tetanus toxoid, and provide supplements
like iron and folic acid to prevent deficiencies.
(b) Difference Between
Full-term and Preterm Baby:
|
Aspect |
Full-term Baby |
Preterm Baby |
|
Gestational Age |
Delivered between 37–42 weeks |
Delivered before 37 weeks |
|
Birth Weight |
Usually >2.5 kg |
Often <2.5 kg |
|
Physical Features |
Well-developed body and organs |
Underdeveloped organs, thin skin |
|
Feeding |
Can
suck and swallow effectively |
May require feeding support |
|
Health Risks |
Lower risk of complications |
Higher risk of respiratory
distress, jaundice, and infections |
(c) Signs and Symptoms
of Puerperal Sepsis:
- Fever:
Persistent fever of 38°C (100.4°F) or higher after childbirth.
- Foul-Smelling Lochia:
Vaginal discharge with a bad odor.
- Pelvic Pain:
Pain or tenderness in the lower abdomen or pelvis.
- Fatigue and Malaise:
Generalized weakness and a feeling of unwellness.
- Tachycardia:
Increased heart rate.
- Chills and Sweating:
Episodes of shaking chills and excessive sweating.
- Signs of Infection:
Redness, swelling, or pain at the site of perineal tears, episiotomy, or
cesarean incision.
Prompt medical attention is crucial for
treating puerperal sepsis to prevent severe complications like septic shock.
VI.
Answer the
following questions 3x5=15
(a) Define ectopic pregnancy and write
sign and symptoms.
(b) What are the investigations done
to diagnose ectopic pregnancy.
(c) Write the nursing management of
ectopic pregnancy.
OR
(a) Define infertility and its types
and the investigations to be carried out in a case of infertility.
(b) What investigations will be
carried out at first antenatal visit?
(c) What advice will you give
regarding diet during pregnancy? Write in detail.
(a) Define ectopic pregnancy and write signs
and symptoms.
Definition:
Ectopic pregnancy occurs when a fertilized ovum implants outside the uterine
cavity, most commonly in the fallopian tube.
Signs and Symptoms:
- Abdominal Pain:
Severe, localized pain in the lower abdomen or pelvis.
- Vaginal Bleeding:
Irregular spotting or bleeding, often darker than normal menstrual blood.
- Missed Period:
Suggestive of pregnancy, often accompanied by a positive pregnancy test.
- Shoulder Tip Pain:
Referred pain due to irritation of the diaphragm from internal bleeding.
- Signs of Shock:
Dizziness, fainting, rapid heartbeat, and low blood pressure in cases of
rupture.
(b) What are the
investigations done to diagnose ectopic pregnancy?
- Ultrasound:
Transvaginal ultrasound to locate the pregnancy.
- Beta-hCG Levels:
Serial measurements to assess abnormal rises in hCG.
- Culdocentesis:
Checking for blood in the pouch of Douglas in cases of suspected rupture.
- Diagnostic Laparoscopy: Direct visualization of the ectopic pregnancy.
- Complete Blood Count (CBC): To check for anemia or infection.
(c) Nursing Management
of Ectopic Pregnancy:
- Monitoring Vital Signs: Regularly monitor blood pressure, pulse, and
respiratory rate for signs of shock.
- Emotional Support:
Provide psychological support to the patient and family due to the
emotional impact.
- Administering Medications: If indicated, administer methotrexate for medical
management or analgesics for pain relief.
- Pre- and Post-Surgery Care: Prepare the patient for surgery if rupture occurs and
provide postoperative care, including wound care and monitoring for
complications.
- Health Education:
Educate the patient about the risk of recurrence and the importance of
early antenatal care in future pregnancies.
OR
(a) Define
infertility, its types, and investigations.
Definition:
Infertility is the inability of a couple to conceive after one year of regular,
unprotected intercourse.
Types of Infertility:
- Primary Infertility:
When a couple has never conceived.
- Secondary Infertility: When a couple has difficulty conceiving after a
previous pregnancy.
Investigations:
- Female Partner:
Ovulation tests, hormonal profile (FSH, LH, prolactin), pelvic ultrasound,
hysterosalpingography (HSG), and laparoscopy.
- Male Partner:
Semen analysis, hormonal tests (testosterone), and scrotal ultrasound.
- Couple:
Genetic testing if indicated.
(b) Investigations at
First Antenatal Visit:
- Complete Blood Count (CBC): To detect anemia or infections.
- Blood Group and Rh Typing: To identify Rh incompatibility.
- Urine Analysis:
To check for infections or proteinuria.
- Blood Sugar Levels:
For screening gestational diabetes.
- HIV, Hepatitis B, and Syphilis Tests: For infections that could affect pregnancy.
- Ultrasound:
To confirm gestational age and rule out abnormalities.
(c) Advice Regarding
Diet During Pregnancy:
- Balanced Diet:
Include carbohydrates, proteins, fats, vitamins, and minerals in proper
proportions.
- Iron-Rich Foods:
Include leafy greens, beans, and red meat to prevent anemia.
- Calcium-Rich Foods:
Milk, cheese, yogurt, and fortified cereals to support fetal bone
development.
- Folic Acid:
Include supplements and foods like spinach, citrus fruits, and lentils to
prevent neural tube defects.
- Hydration:
Drink 8-10 glasses of water daily to maintain hydration.
- Avoid Certain Foods:
Avoid raw or undercooked meats, unpasteurized dairy, and high-mercury fish
like shark and swordfish.
- Frequent Small Meals:
To prevent nausea and maintain energy levels.
VII.
Mrs Veena
30 years old with 2nd Gravida 3rd para is admitted with H/o of 9 months
amenorrhoea with causeless painless bleeding per vagina, her B.P. is 120/70 mm
of Hg. Answer the following questions 2+3+5+5=15
(a) What is APH? What are the causes of antipartum
haemorrhage?
(b) List the Investigations to be carried out for Mrs.
Veena
(c) Write in brief obsterical and nursing management
of Mrs, Veena.
(d) What health advice will you give to Mrs. Veena
during discharge from the hospital?
(a) What is APH? What
are the causes of antepartum hemorrhage?
Definition: Antepartum hemorrhage (APH) is bleeding from the genital
tract occurring after 20 weeks of gestation and before the onset of labor.
Causes of APH:
- Placenta Previa:
Placenta implanted in the lower uterine segment.
- Abruptio Placentae:
Premature separation of a normally implanted placenta.
- Uterine Rupture:
Rare but can cause severe bleeding.
- Vasa Previa:
Fetal blood vessels cross or run near the internal os.
- Cervical or Vaginal Lesions: Such as cervical polyps, infections, or varicose
veins.
(b) List the
Investigations to be carried out for Mrs. Veena
- Ultrasound:
To determine placental location and identify conditions like placenta
previa or abruptio placentae.
- Blood Tests:
- Complete Blood Count (CBC) to assess anemia and
hemoglobin levels.
- Blood grouping and crossmatching in case transfusion
is needed.
- Coagulation Profile:
To check for clotting disorders.
- Non-Stress Test (NST): To monitor fetal well-being.
- Urine Analysis:
To rule out urinary tract infections.
- Speculum Examination:
To assess for cervical or vaginal lesions (if indicated and bleeding is
minimal).
(c) Obstetrical and
Nursing Management of Mrs. Veena
Obstetrical Management:
- Monitor Bleeding:
Regular assessment of vaginal bleeding, vital signs, and fetal heart rate.
- Hospitalization:
Ensure she remains in a healthcare setting for close monitoring.
- Ultrasound:
Confirm the cause of bleeding (e.g., placenta previa or abruption).
- Delivery Decision:
- If bleeding is severe, prepare for emergency delivery
(cesarean section if placenta previa is confirmed).
- If term and stable, plan delivery under controlled
conditions.
Nursing Management:
- Positioning:
Place the patient in a left lateral position to improve uteroplacental
perfusion.
- Monitor Maternal Vital Signs: Blood pressure, pulse, and respiratory rate at regular
intervals.
- Fetal Monitoring:
Monitor fetal heart rate continuously.
- IV Access and Fluids:
Establish IV access to administer fluids or blood products as needed.
- Emotional Support:
Provide psychological support to Mrs. Veena and her family.
(d) Health Advice for
Mrs. Veena at Discharge:
- Avoid Strenuous Activities: Advise rest and avoidance of heavy lifting or physical
exertion.
- Monitor Symptoms:
Report any vaginal bleeding, abdominal pain, or reduced fetal movements
immediately.
- Follow-Up Visits:
Schedule regular follow-ups with her obstetrician to monitor maternal and
fetal health.
- Dietary Advice:
- Include iron-rich foods (e.g., spinach, red meat) and
iron supplements to recover from blood loss.
- Ensure adequate hydration and a balanced diet.
- Hygiene and Wound Care: If a cesarean section was performed, educate on proper
wound care to prevent infections.
- Family Planning Advice: Provide counseling on appropriate spacing between
pregnancies and contraceptive methods if needed.
- Breastfeeding Guidance: Encourage breastfeeding and educate on its benefits
for both the mother and baby.