GNM 2nd year paper -I MEDICAL SURGICAL FEBRUARY 2019
KARANATAKA
STATE DIPLOMA IN NURSING EXAMINATION BOARD
GNM
SUPPLEMENTARY EXAMINATION FEBRUARY 2019
2nd year
paper -I MEDICAL SURGICAL NURSING - I
Duration: 3 Hours Max.Marks:75
----------------------------------------------------------------------------------------------------------
I. Give the
meaning of the following: 1x4=4
a) Osmosis b)
Hypoxemia c) Glossitis d) Emesis
a) Osmosis: The process by which water molecules move
across a semi-permeable membrane from an area of lower solute concentration to
an area of higher solute concentration, aiming to equalize solute
concentrations on both sides of the membrane.
b) Hypoxemia: A condition characterized by low levels of
oxygen in the blood, specifically in the arteries, which can lead to symptoms
such as shortness of breath and fatigue.
c) Glossitis: Inflammation of the tongue, which may cause
it to appear swollen, red, and smooth. It is often associated with discomfort
or pain and can result from various causes, including nutritional deficiencies,
infections, or allergic reactions.
d) Emesis: The medical term for vomiting, which is the forceful
expulsion of stomach contents through the mouth. It can be caused by various
factors, such as illness, poisoning, or motion sickness.
II.
Fill in the
blanks: 1x4=4
a) Gingivitis is the inflammation of the gums.
b) Decrease level of potassium in the blood is called Hypokalemia.
c) Cholecystitis is inflammation of the gall bladder.
d) Syncope is a sudden temporary loss of consciousness.
III.
Write short
notes on any FOUR of the following: 4x4=16
a)
Peritonitis b) Cholecystitis c) Pancreatitis d) Appendicitis e) Pneumonia
a) Peritonitis
Peritonitis is the inflammation of the peritoneum, the thin membrane
lining the abdominal cavity and covering the abdominal organs. It can result
from infection (bacterial or fungal) due to a ruptured appendix, stomach ulcer,
or injury. Symptoms include severe abdominal pain, fever, nausea, vomiting, and
a rigid abdomen. Peritonitis is a medical emergency and requires prompt
treatment, typically with antibiotics and sometimes surgery to address the
underlying cause.
b) Cholecystitis
Cholecystitis is the inflammation of the gallbladder, most commonly
caused by gallstones blocking the cystic duct. It can also result from
infections or trauma. Symptoms include severe pain in the upper right abdomen,
fever, nausea, and vomiting. Chronic cases can lead to scarring and dysfunction
of the gallbladder. Treatment may involve antibiotics, pain management, and, in
severe cases, surgical removal of the gallbladder (cholecystectomy).
c) Pancreatitis
Pancreatitis is the inflammation of the pancreas, an organ that produces
digestive enzymes and hormones like insulin. It can be acute (sudden onset) or
chronic (long-term). Common causes include gallstones, excessive alcohol
consumption, and certain medications. Symptoms include severe abdominal pain,
nausea, vomiting, and fever. Treatment focuses on pain relief, fasting to rest
the pancreas, IV fluids, and addressing the underlying cause.
d) Appendicitis
Appendicitis is the inflammation of the appendix, a small, finger-shaped
pouch attached to the large intestine. It is often caused by a blockage in the
appendix, leading to infection. Symptoms include sudden pain in the lower right
abdomen, fever, nausea, and loss of appetite. If untreated, the appendix can
rupture, causing peritonitis. Treatment typically involves surgical removal of
the appendix (appendectomy).
e) Pneumonia
Pneumonia is an infection of the lungs that causes inflammation in the
air sacs (alveoli), which may fill with fluid or pus. It can be caused by
bacteria, viruses, fungi, or other microorganisms. Symptoms include cough
(often with mucus), fever, difficulty breathing, chest pain, and fatigue.
Treatment depends on the cause and may include antibiotics, antivirals, or
antifungals, along with supportive care like oxygen therapy.
IV.
Answer the
Following 1+3+3=7
(a) Define Hernia
b) List out the types and clinical manifestation of
Hernia
c) Explain the treatment and nursing management of
client with inguinal Hernia
(a)
Define Hernia
A hernia is the abnormal protrusion of an organ or tissue through a weak
spot or opening in the surrounding muscle or connective tissue. It commonly
occurs in the abdominal wall but can also develop in other areas.
----------------------------------------------------------------------------------------------------------
(b) Types and Clinical Manifestations of
Hernia
Types of Hernia:
- Inguinal
Hernia: Protrusion through the inguinal canal; more common
in males.
- Femoral
Hernia: Bulge near the upper thigh or groin; more common
in females.
- Umbilical
Hernia: Occurs around the navel, common in infants and
pregnant women.
- Incisional
Hernia: Develops at the site of a previous surgical
incision.
- Hiatal
Hernia: Protrusion of the stomach through the diaphragm
into the chest cavity.
- Epigastric
Hernia: Occurs between the navel and lower chest.
Clinical Manifestations:
- Visible
bulge in the affected area, which may increase in size with straining or
coughing.
- Pain or
discomfort at the site of the hernia.
- A
feeling of heaviness or pressure.
- In some
cases, nausea, vomiting, or difficulty swallowing (e.g., hiatal hernia).
- Signs of strangulation (emergency): Severe pain, redness, fever, and inability to push the hernia back in.
----------------------------------------------------------------------------------------------------------
(c) Treatment and Nursing Management of
a Client with Inguinal Hernia
Treatment:
- Non-surgical
Management:
- Use
of a hernia truss or support belt to prevent further protrusion (not a
permanent solution).
- Surgical
Management:
- Herniorrhaphy:
Surgical repair of the hernia by pushing the protruding organ back and
repairing the weak spot.
- Hernioplasty:
Repair of the hernia using a mesh to reinforce the weakened area.
- Laparoscopic
surgery is a minimally invasive option.
Nursing Management:
1. Preoperative
Care:
- Assess
and document the size and symptoms of the hernia.
- Educate
the patient about the procedure and postoperative expectations.
- Ensure
the patient is fasting as per surgical guidelines.
2. Postoperative
Care:
- Monitor
vital signs and surgical site for signs of infection or complications.
- Manage
pain with prescribed analgesics.
- Encourage
deep breathing exercises to prevent respiratory complications.
- Advise
the patient to avoid heavy lifting and straining for a few weeks.
- Educate
the patient about proper wound care and the importance of follow-up
appointments.
3. Lifestyle
Modifications:
- Encourage
maintaining a healthy weight.
- Advise
avoiding activities that increase intra-abdominal pressure (e.g., heavy
lifting, constipation).
- Promote
a balanced diet to prevent straining during bowel movements.
By addressing both the surgical and nursing care aspects, complications such
as recurrence or infection can be minimized, and patient recovery can be
enhanced.
V.
Answer the
Following: 1+3+3=7
a) Define CVA
b) List out the causes and clinical
manifestation of CVA
c) Explain Medical and Nursing
Management of patient with CVA
(a) Define CVA
CVA, or Cerebrovascular Accident, commonly known as a
stroke, is a sudden interruption of blood flow to the brain, leading to brain
cell damage or death. This occurs due to either a blockage (ischemic stroke) or
rupture (hemorrhagic stroke) of a blood vessel in the brain.
----------------------------------------------------------------------------------------------------------
(b) Causes and Clinical Manifestations
of CVA
Causes:
- Ischemic
Stroke (most common):
- Thrombosis:
A blood clot forms in a cerebral artery, blocking blood flow.
- Embolism:
A blood clot or other debris travels from another part of the body and
blocks a cerebral artery.
- Hemorrhagic
Stroke:
- Intracerebral
hemorrhage: Rupture of a blood vessel within the brain.
- Subarachnoid
hemorrhage: Bleeding into the space between the brain and the thin
tissues covering the brain, often due to a ruptured aneurysm.
- Transient
Ischemic Attack (TIA): A temporary blockage of blood flow
to the brain, also called a "mini-stroke."
- Risk
Factors: Hypertension, diabetes, smoking, obesity, high cholesterol,
atrial fibrillation, and family history of stroke.
Clinical Manifestations:
- Sudden
weakness or numbness in the face, arm, or leg, especially on one side of
the body.
- Difficulty
speaking or understanding speech (aphasia).
- Vision
problems in one or both eyes.
- Sudden
dizziness, loss of balance, or coordination.
- Severe
headache with no known cause.
- Loss of consciousness in severe cases.
----------------------------------------------------------------------------------------------------------
(c) Medical and Nursing Management of a
Patient with CVA
Medical Management:
1. Initial
Management:
- Ensure
airway patency, breathing, and circulation (ABCs).
- Administer
oxygen to maintain adequate oxygenation.
- Perform
immediate imaging (CT or MRI) to distinguish between ischemic and
hemorrhagic stroke.
2. Ischemic
Stroke Treatment:
- Thrombolytic
therapy: Administration of tissue plasminogen activator
(tPA) within 3-4.5 hours of symptom onset to dissolve clots.
- Antiplatelet
agents: Aspirin or clopidogrel to prevent further clot
formation.
- Anticoagulants:
In cases of atrial fibrillation to prevent recurrent strokes.
3. Hemorrhagic
Stroke Treatment:
- Control
blood pressure with antihypertensive medications.
- Surgical
interventions (e.g., clipping or coiling of aneurysms) to prevent further
bleeding.
- Administer
medications to reduce brain swelling (e.g., mannitol).
Nursing Management:
1. Acute
Phase:
- Monitor
vital signs and neurological status frequently (Glasgow Coma Scale).
- Position
the patient in a semi-Fowler's position to reduce intracranial pressure
(ICP).
- Ensure
proper hydration and nutrition (may require enteral feeding if swallowing
is impaired).
- Monitor
for complications such as aspiration, deep vein thrombosis (DVT), or
infections.
2. Rehabilitation
Phase:
- Assist
the patient in regaining mobility through physical therapy (e.g., range
of motion exercises).
- Encourage
speech therapy for patients with aphasia or dysarthria.
- Promote
occupational therapy for activities of daily living (ADLs).
- Educate
the patient and family about secondary stroke prevention (e.g.,
controlling blood pressure, quitting smoking, and adhering to prescribed
medications).
3. Psychosocial
Support:
- Provide
emotional support to the patient and family, as stroke recovery can be a
prolonged and challenging process.
- Encourage
participation in support groups.
Effective medical and nursing management can improve outcomes, prevent complications, and enhance the quality of life for patients with CVA.
SECTION-II
VI.
State the following
statements are TRUE or FALSE 1x4=4
a) Cholecystitis is the inflammation of Urinary bladder
b) Lordosis is the lateral curvature of the spine
c) Bell's palsy affects the facial muscles
d) Bleeding from nose is known as Epistaxis
a) False – Cholecystitis is the inflammation of the gallbladder,
not the urinary bladder.
b) False – Lordosis refers to an excessive inward curvature
of the lower spine (lumbar region), not a lateral curvature. Scoliosis
is the lateral curvature of the spine.
c) True – Bell's palsy affects the facial muscles,
typically causing temporary weakness or paralysis on one side of the face due
to facial nerve dysfunction.
d) True – Bleeding from the nose is known as Epistaxis.
VII. Choose the correct answer and write: 1x3=3
a) Following instrument is used for examination of eye
i.
Gastroscopy ii. Opthalmoscopy iii. Protoscopy
b) Bluish discoloration of the skin is termed as
i. Cyanosis ii. Jaundice iii. Dermatitis
c) Slat is restricted to the patient with
i. Fever ii. Diabetes iii. Hypertension
Answers:
a) Following instrument is used for the examination of the eye:
ii. Ophthalmoscopy
b) Bluish discoloration of the skin is termed as:
i. Cyanosis
c) Salt is restricted to the patient with:
iii. Hypertension
VIII.
Write short
notes any FOUR of the following: 4x4=16
a) Atelectasis b)
Intestinal obstruction c)
Meningitis d) Jaundice
a) Atelectasis
Atelectasis is the partial or
complete collapse of the lung or a lobe of the lung, resulting in reduced gas
exchange. It occurs when the alveoli become deflated or filled with fluid.
Causes include airway obstruction (e.g., mucus plugs, foreign bodies),
compression from a tumor or pleural effusion, or post-surgical complications.
Symptoms include shortness of breath, chest pain, and reduced oxygen levels.
Treatment focuses on addressing the underlying cause, such as suctioning,
bronchodilators, or physiotherapy to improve lung expansion.
----------------------------------------------------------------------------------------------------------
b) Intestinal
Obstruction
Intestinal obstruction occurs when
the normal flow of intestinal contents is blocked, either partially or
completely. This can result from mechanical causes (e.g., tumors, adhesions,
hernias) or functional causes (e.g., paralytic ileus). Symptoms include
abdominal pain, bloating, nausea, vomiting, and absence of bowel movements or
flatus. Diagnosis involves imaging studies like X-rays or CT scans. Treatment
depends on the cause and may involve decompression with a nasogastric tube, IV
fluids, and surgery in severe cases.
----------------------------------------------------------------------------------------------------------
c) Meningitis
Meningitis is the inflammation of
the meninges, the protective membranes surrounding the brain and spinal cord.
It is caused by bacterial, viral, fungal, or other infections. Symptoms include
fever, headache, stiff neck, photophobia, nausea, vomiting, and altered mental
status. Bacterial meningitis is a medical emergency requiring prompt antibiotic
treatment, while viral meningitis is usually self-limiting. Nursing care involves
isolation precautions, monitoring neurological status, and managing symptoms
like fever and pain.
----------------------------------------------------------------------------------------------------------
d) Jaundice
Jaundice is a condition
characterized by yellowing of the skin, mucous membranes, and eyes due to
elevated bilirubin levels in the blood. It results from liver dysfunction,
excessive breakdown of red blood cells, or obstruction of bile flow (e.g.,
gallstones, tumors). Types include pre-hepatic (hemolytic), hepatic
(liver-related), and post-hepatic (obstructive). Symptoms may include yellow
discoloration, dark urine, pale stools, and itching. Treatment focuses on
addressing the underlying cause, such as treating infections, removing
obstructions, or managing liver disease.
IX.
Answer the
Following: 1+3+3=7
a) Define COPD
b) List out the clinical manifestation of COPD
c) Discuss with detail nursing management of patient
with COPD
(a) Define COPD
COPD, or Chronic Obstructive Pulmonary Disease, is a
progressive lung disease characterized by chronic airflow limitation due to
damage in the airways or alveoli. It includes conditions such as chronic
bronchitis and emphysema. It is commonly caused by long-term exposure to
irritants like cigarette smoke, air pollution, or occupational hazards.
----------------------------------------------------------------------------------------------------------
(b) Clinical Manifestations of COPD
1. Respiratory
Symptoms:
- Chronic
cough (often productive with sputum).
- Shortness
of breath (dyspnea), especially during physical activity.
- Wheezing
or noisy breathing.
2. Systemic
Symptoms:
- Fatigue
or weakness.
- Weight
loss due to increased energy expenditure and reduced appetite.
3. Physical
Signs:
- Barrel-shaped
chest (due to hyperinflation of lungs).
- Use
of accessory muscles for breathing.
- Cyanosis
(bluish discoloration of lips and fingers) in severe cases.
4. Exacerbations:
- Episodes of worsening symptoms, often triggered by infections or environmental factors.
----------------------------------------------------------------------------------------------------------
(c) Nursing Management of a Patient with
COPD
1. Assessment and Monitoring:
- Monitor
vital signs and respiratory rate.
- Assess
for signs of hypoxia (cyanosis, restlessness).
- Perform
pulse oximetry to monitor oxygen saturation.
- Document
the frequency and severity of cough and sputum production.
2. Oxygen Therapy:
- Administer
oxygen as prescribed, ensuring flow rates are kept low (1–2 liters per
minute) to avoid suppressing the hypoxic drive in COPD patients.
- Monitor
for oxygen toxicity.
3. Breathing Techniques:
- Teach
the patient pursed-lip breathing
to improve oxygen exchange and reduce shortness of breath.
- Encourage
diaphragmatic
breathing for better lung expansion.
4. Airway Clearance:
- Encourage
effective coughing to clear mucus.
- Provide
chest physiotherapy or postural drainage if necessary.
- Ensure
adequate hydration to loosen secretions.
5. Medication Management:
- Administer
bronchodilators (e.g., salbutamol, ipratropium) to open airways.
- Use
corticosteroids to reduce inflammation.
- Provide
antibiotics during infections or exacerbations.
6. Lifestyle Modifications:
- Educate
the patient about smoking cessation and avoiding exposure to irritants.
- Encourage
a balanced diet to maintain energy levels and prevent weight loss.
- Promote
regular physical activity to improve endurance and lung function.
7. Psychosocial Support:
- Address
anxiety or depression, which is common in COPD patients.
- Encourage
participation in support groups or pulmonary rehabilitation programs.
8. Preventing Complications:
- Advise
vaccination against influenza and pneumococcal infections.
- Monitor
for signs of right-sided heart failure (cor pulmonale) or acute
respiratory failure.
Effective nursing care for COPD focuses on improving the patient’s quality
of life, minimizing exacerbations, and preventing complications.
X.
Answer the
Following: 1+3+3=7
a) Define peptic ulcer
b) List out the clinical manifestation and diagnosis
of peptic ulcer
c) Explain the management of patient with peptic ulcer
(a) Define Peptic Ulcer
A peptic ulcer is an open sore or lesion that develops
on the inner lining of the stomach, duodenum (the first part of the small
intestine), or esophagus. It is caused by an imbalance between aggressive
factors (like gastric acid and pepsin) and protective mechanisms (like mucus
and bicarbonate). Common causes include Helicobacter pylori infection and
long-term use of NSAIDs.
----------------------------------------------------------------------------------------------------------
(b) Clinical Manifestations and
Diagnosis of Peptic Ulcer
Clinical Manifestations:
- Pain:
- Burning
or gnawing pain in the upper abdomen, typically between meals or at
night.
- Pain
may be relieved temporarily by eating or taking antacids.
- Other
Symptoms:
- Nausea
or vomiting.
- Bloating
or fullness after eating.
- Loss
of appetite or unintentional weight loss.
- Dark
or tarry stools (indicating bleeding in the gastrointestinal tract).
- Vomiting
blood (hematemesis) in severe cases.
Diagnosis:
- Endoscopy
(EGD):
- Direct
visualization of the ulcer in the stomach or duodenum.
- Biopsy
may be performed to check for Helicobacter pylori
infection or rule out malignancy.
- H.
pylori Testing:
- Urea
breath test, stool antigen test, or blood test.
- Imaging:
- Barium
swallow X-ray to detect ulcers.
- Laboratory
Tests:
- Complete blood count (CBC) to check for anemia due to blood loss.
----------------------------------------------------------------------------------------------------------
(c) Management Of Patient With Peptic Ulcer
1. Medical Management:
- Antibiotics:
To eradicate H. pylori
infection (e.g., a combination of amoxicillin, clarithromycin, and a
proton pump inhibitor).
- Proton
Pump Inhibitors (PPIs): To reduce gastric acid secretion
(e.g., omeprazole, pantoprazole).
- H2
Receptor Antagonists: To decrease acid production (e.g.,
ranitidine, famotidine).
- Antacids:
To neutralize stomach acid and relieve pain.
- Cytoprotective
Agents: Medications like sucralfate or misoprostol to
protect the stomach lining.
2. Lifestyle Modifications:
- Avoid irritants
such as spicy foods, alcohol, smoking, and caffeine.
- Eat
smaller, more frequent meals to reduce acid production.
- Reduce
stress through relaxation techniques or counseling.
3. Surgical Management (for Complications):
- Vagotomy:
Cutting the vagus nerve to reduce acid secretion.
- Partial
Gastrectomy: Removal of the affected part of the stomach.
- Pyloroplasty:
Enlargement of the pyloric opening to improve gastric emptying.
4. Nursing Management:
- Monitor
for signs of complications like perforation, bleeding, or obstruction
(e.g., sudden severe pain, black stools, vomiting blood).
- Educate
the patient about medication adherence, diet, and avoiding risk factors.
- Encourage
adequate hydration and nutritional support during recovery.
- Provide
emotional support to help cope with the condition and lifestyle changes.
By combining medical, lifestyle, and nursing interventions, peptic ulcer
patients can achieve symptom relief, ulcer healing, and prevention of
complications.
