2nd Year GNM Nursing ODISHA Medical and Surgical Nursing I 2025
ODISHA NURSES & MIDWIVES EXAMINATION BOARD
SECOND YEAR ANNUAL EXAMINATION IN GNM-2025
Paper-I
(Medical and Surgical Nursing I)
I. Solve answer question
OR
a) What is renal failure [3 marks]
Renal
failure (also called renal insufficiency or kidney failure) is a condition in
which the kidneys are unable to adequately filter waste products, remove excess
fluid, and maintain electrolyte and acid-base balance in the body. In other
words, the kidneys’ excretory, regulatory and endocrine functions are markedly
impaired.
Renal failure may be acute (sudden onset) or chronic (gradual,
progressive) in nature.
b) Aetiology, clinical presentation and complications of chronic renal
failure [5 marks]
Aetiology
(Causes) of Chronic Renal Failure
Chronic renal failure (often termed chronic kidney disease – CKD) develops when
there is long-standing damage to the kidneys or their blood supply, tubules,
glomeruli, or urinary tract, resulting in progressive loss of function.
Major causes include:
- Diabetes mellitus
(especially long-standing) – a leading cause of CKD worldwide.
- Hypertension (high blood
pressure) – which damages renal blood vessels & glomeruli.
- Glomerulonephritis and
chronic tubulo-interstitial nephritis (infections, autoimmune etc) –
damage the filtering units of kidneys.
- Polycystic kidney disease
(hereditary), urinary tract obstruction (long-term), repeated kidney
infections or kidney stones.
- Chronic reduced renal
perfusion (e.g., heart failure, cirrhosis) can lead to prerenal damage and
eventual CKD.
Clinical
Presentation (Signs & Symptoms)
Because kidneys have a large functional reserve, early chronic renal failure
may be fairly asymptomatic. But as it progresses, typical features include:
- Fatigue, weakness, lethargy
(because of uremia, anaemia)
- Loss of appetite, nausea,
vomiting, metallic taste in mouth.
- Changes in urine output:
more frequent urination especially at night (nocturia) in early stages,
later may have oliguria (reduced output) or dark/foamy urine.
- Swelling/edema of feet,
ankles, around eyes (due to fluid retention)
- High blood pressure
(hypertension) or worsening hypertension.
- Skin changes: itching
(pruritus), dryness, pale skin (due to anaemia)
- Muscle cramps, bone pain (due
to mineral/bone disorder)
- Confusion, difficulty
concentrating (due to toxin build-up)
Complications
Chronic renal failure leads to a wide range of systemic complications. Some
important ones are:
- Anaemia: failing kidneys produce less
erythropoietin → reduced RBC production → anaemia.
- Mineral and bone disorder: impaired activation of
vitamin D, phosphate retention, hypocalcaemia → bone demineralisation,
fractures, osteomalacia.
- Cardiovascular disease: hypertension, fluid
overload, electrolyte disturbances (e.g., hyper-potassaemia), accelerated
atherosclerosis.
- Fluid and electrolyte
imbalances:
hyperkalaemia, metabolic acidosis, fluid overload/edema, uremic symptoms.
- End-stage renal disease
(ESRD)
requiring dialysis or transplant.
- Increased risk of infections (immune dysfunction) and
bleeding tendencies may also appear.
c) Nursing management of a patient with chronic renal failure [7 marks]
A nursing
management plan for a patient with chronic renal failure should focus on
holistic care — managing symptoms, complications, promoting patient education
and supporting treatment (including dialysis if required). Below is an outline
of nursing interventions you should include:
1.
Assessment
- Take a detailed history:
underlying causes (diabetes, hypertension, UTIs, stones), past renal
problems, medications, diet, fluid intake, urinary changes.
- Monitor vital signs (BP,
pulse, respiratory rate) and observe for signs of fluid overload (edema, crackles
in lungs), hypertension.
- Assess urine output (volume,
colour, presence of foaming, blood), daily weight to track fluid
retention.
- Observe for symptoms of
uremia: nausea, vomiting, lethargy, pruritus, confusion.
- Monitor lab investigations:
BUN/creatinine, GFR/estimated GFR, electrolytes (K⁺, Ca²⁺, PO₄³⁻),
haemoglobin (for anaemia), acid-base status.
- Review nutrition status
(appetite, weight changes), skin condition, bone/joint pain.
2.
Planning/Goals
- Maintain fluid balance and
prevent fluid overload.
- Maintain optimal
electrolyte/acid-base balance.
- Prevent or treat
complications (anaemia, bone disease, cardiovascular issues).
- Support renal function as
far as possible and prepare for dialysis/transplant if needed.
- Educate patient and family
about condition, treatment, lifestyle modifications.
3.
Nursing Interventions
- Fluid management: Monitor intake and output
closely; restrict fluids if ordered; check daily weights; observe for
signs of overload (e.g., oedema, breathlessness).
- Dietary management: Collaborate with
dietician. Encourage low-protein diet if required (to reduce waste
build-up), low-salt, potassium and phosphorus restricted diet (depending
on lab results). Educate patient about avoiding high-potassium foods
(bananas, avocados, potatoes), phosphorus (dairy, cola) etc.
- Monitor electrolytes &
acid-base:
Administer medications as prescribed (e.g., phosphate binders, calcium
supplements, sodium bicarbonate for acidosis), monitor for hyperkalaemia
and intervene early.
- Blood pressure control: Ensure adherence to
antihypertensive therapy; monitor BP; teach about lifestyle (diet,
exercise, stopping smoking).
- Anaemia management: Monitor haemoglobin;
support erythropoietin therapy if prescribed; ensure adequate iron,
folate, vitamin B12 as per policy.
- Bone & mineral care: Monitor calcium, phosphate
and PTH levels; support medication adherence; encourage weight-bearing
exercises as tolerated; monitor for bone pain and fractures.
- Skin care & pruritus
relief:
For itchy skin, keep skin clean, moisturised; control uremia; avoid harsh
soaps; keep nails trimmed to avoid scratching.
- Patient education: Teach about the nature of
the disease (irreversibility, progressive nature), importance of strict
control of diabetes/hypertension, diet and fluid restrictions, medication
adherence, signs of complications (e.g., swelling, decreased urine,
breathlessness).
- Prepare for renal
replacement therapy: If indicated, educate and assist patient for
haemodialysis/peritoneal dialysis; monitor access site (fistula, catheter)
for infection or complications; ensure schedule adherence.
- Psychosocial support: Chronic renal failure is
long-term; support coping, anxiety or depression; involve family; refer to
counsellor if needed.
- Prevent infection: Because of
immunosuppression and dialysis risks, practise strict asepsis; monitor for
signs of infection (especially at access sites), teach about hygiene.
- Monitor complications: Watch for cardiovascular
complications (e.g., heart failure, arrhythmias), hyperkalaemic
emergencies, bleeding tendencies. Promptly report.
4.
Evaluation
- Regular review of renal
function tests, electrolytes, haemoglobin.
- Observe if patient maintains
stable weight, controlled BP, absence of oedema, no worsening of symptoms
(nausea, vomiting, fatigue).
- Patient adheres to
diet/fluid/medications and understands disease process.
- No occurrence (or early
management) of complications.
Summary
To recap:
- Renal failure means the
kidneys fail to adequately filter and regulate, either suddenly or
gradually.
- In chronic renal failure the
damage is long-standing: key causes include diabetes, hypertension,
glomerular disease; the presentation is often subtle at first but later
includes fatigue, oedema, urinary changes, hypertension and complications
such as anaemia, bone disease, cardiovascular issues.
- Nursing management focuses
on assessment, maintaining fluid/electrolyte/blood pressure balance, diet
& nutrition, patient education, preparation for dialysis/transplant,
prevention of complications and providing psychosocial support.
a) Define Shock [3 marks]
Shock is
a life-threatening condition in which the circulatory system fails to provide
adequate blood flow (perfusion) to the body’s tissues and organs, resulting in
inadequate oxygen and nutrient delivery to cells, leading to cellular dysfunction
and organ failure.
In simpler terms: when the body cannot maintain effective tissue perfusion (due
to low volume, pump failure, vessel failure or obstruction), shock occurs.
b) Types of Shock, its clinical manifestations and complications [6
marks]
Types of
Shock
There are broadly four major categories of shock:
- Hypovolemic shock – due to loss of blood or
fluid volume (e.g., severe bleeding, dehydration, burns)
- Cardiogenic shock – pump failure of the heart
(e.g., myocardial infarction, severe heart failure)
- Obstructive shock – physical obstruction of
blood flow (e.g., tension pneumothorax, cardiac tamponade, pulmonary
embolism)
- Distributive shock – widespread vasodilation
and maldistribution of blood flow. This includes:
- Septic shock (infection)
- Anaphylactic shock
(allergic reaction)
- Neurogenic shock (spinal
cord injury)
Clinical
Manifestations
While manifestations vary by type, common features of shock include:
- Hypotension (low blood
pressure) or drop from baseline
- Tachycardia (rapid weak
pulse)
- Rapid, shallow breathing;
signs of respiratory distress
- Cool, clammy, pale skin (in
many types) and delayed capillary refill (except in some distributive
types where skin may be warm)
- Altered mental status:
restlessness, anxiety, confusion or unconsciousness
- Reduced urine output
(oliguria) due to kidney hypoperfusion
- Other skin changes: mottling,
cyanosis of lips/fingernails
If you
want, I can include specific manifestations per type of shock:
- Hypovolemic: thirst, cold
extremities, weak pulses
- Cardiogenic: chest pain,
pulmonary oedema, signs of heart failure
- Obstructive: jugular venous
distension, obstructive causes signs
- Distributive: warm flushed
skin (early septic), massive vasodilation, bradycardia in neurogenic type
Complications
If shock persists without prompt correction, several serious complications may
develop:
- Multiple organ dysfunction
syndrome (MODS) – kidneys, liver, heart, lungs fail due to prolonged hypoperfusion.
- Acute kidney injury / renal
failure (because of reduced perfusion)
- DIC (disseminated
intravascular coagulation) in severe septic shock
- Irreversible cellular
damage, tissue necrosis, acidosis (lactic acidosis) due to anaerobic
metabolism.
- Death (high mortality if
untreated)
c) Nursing management of a patient with shock according to priority
basis [6 marks]
The
nursing management of shock must follow a prioritized approach: first immediate
life-saving interventions, then stabilization, then ongoing
monitoring and supportive care.
Priority
nursing actions
- Immediate Assessment &
Support of Airway, Breathing, Circulation (ABC)
- Ensure airway is patent; if
respiratory distress, assist ventilation or intubate if needed.
- Provide supplemental oxygen
to support tissue oxygenation.
- Establish large-bore IV
access for fluid/medication administration.
- Monitor vital signs (BP,
HR, RR, SpO₂), level of consciousness, urine output.
- Lay patient flat or in
Trendelenburg (if no contraindication) to improve venous return and
perfusion.
- Stop the cause if
identifiable (e.g., control bleeding in hypovolemic shock).
- Volume resuscitation &
hemodynamic support
- In hypovolemic shock:
infuse crystalloids / blood products as ordered to restore intravascular
volume.
- In
cardiogenic/obstructive/distributive types: support with vasopressors /
inotropes as prescribed. Monitor for fluid overload in cardiogenic type.
- Monitor central venous
pressure (CVP), if available, or surrogate markers like urine output and
skin perfusion.
- Monitor for signs of fluid
overload (especially in cardiogenic shock): pulmonary oedema, crackles,
increased RR.
- Monitoring tissue perfusion
& organ function
- Hourly urine output; aim
for ≥0.5 mL/kg/hr (or institutional target).
- Skin assessment:
temperature, capillary refill, colour.
- Mental status changes:
restlessness may indicate worsening perfusion.
- Lab monitoring: lactate
levels (indicator of tissue hypoxia), base excess, arterial blood gases,
kidney and liver function, electrolytes.
- Cardiac monitoring: ECG for
arrhythmias, especially in cardiogenic and distributive shock.
- Identification and treatment
of underlying cause
- If hemorrhage → stop
bleeding, surgical intervention as needed.
- If septic shock → obtain
cultures, administer antibiotics promptly, fluid + vasopressors.
- If anaphylactic shock →
epinephrine, antihistamines, fluid support, airway management.
- If neurogenic shock (spinal
injury) → immobilize spine, vasopressors for vasodilation.
- If obstructive shock (e.g.,
tamponade) → immediate removal of obstruction (pericardiocentesis).
- Supportive care &
nursing interventions
- Maintain normothermia (cold
can worsen vasoconstriction).
- Manage pain and anxiety
(they increase oxygen consumption).
- Positioning: raise legs if
tolerated (improve venous return) unless contraindicated.
- Skin care: because of poor
perfusion, risk of pressure ulcers increases.
- Nutrition: after
stabilisation, provide adequate nutrition to support metabolic needs.
- Prevent complications:
monitor for DIC, kidney injury, ARDS (acute respiratory distress
syndrome), stress ulcers, infections.
- Patient/family education and
psychological support
- Explain condition in simple
words, what interventions are being done, importance of monitoring, why
fluids/medications are needed.
- Provide emotional support:
many patients are frightened; family involvement helps.
- Teach signs of
deterioration (e.g., confusion, reduced urine output, shortness of
breath) once patient is stable.
- Ensure documentation of all
observations and timely reporting of changes to medical staff.
Evaluation
- Hemodynamic parameters
stabilise: BP within target, pulse rate acceptable, good perfusion (warm
extremities, capillary refill normal).
- Adequate urine output
maintained.
- No further deterioration of
organ functions; labs improving (e.g., lactate decreasing).
- Underlying cause being
resolved or managed.
- Patient remains alert (or
improving), complications prevented.
Summary
To recap:
- Shock is a critical reduction in
tissue perfusion leading to cellular and organ dysfunction.
- There are four main types
of shock (hypovolemic, cardiogenic, obstructive, distributive) each
with specific causes, signs and complications.
- Nursing management follows a priority basis:
airway/breathing/circulation → volume/vascular support → monitoring
perfusion/organ function → treating underlying cause → supportive care
& education.
II. Solve Answer Questions
OR
a. What is Osteoarthritis? [2 marks]
Osteoarthritis (OA) is a chronic degenerative joint disease characterised by
breakdown of articular cartilage, changes in the bone (sub-chondral bone
sclerosis, osteophytes), alterations in the joint capsule and synovium, and
resultant pain, stiffness and loss of function of the affected joint.
It is also commonly referred to as “wear-and-tear” arthritis (though the changes
are more complex than just wear).
b. Causes, Signs & Symptoms and Diagnostic Tests for
Osteoarthritis [7 marks]
Causes / Aetiology
·
Ageing is a major risk factor: as we age,
cartilage becomes more brittle, repair capacity declines.
·
Female gender (especially after menopause) has
higher risk.
·
Obesity / overweight: excess mechanical load on
joints (especially knees, hips) accelerates cartilage breakdown.
·
Previous joint injury or trauma (e.g., meniscal
tear, ligament injury), joint surgery – leading to secondary OA.
·
Congenital or structural joint abnormalities
(e.g., abnormal alignment), leading to uneven load distribution.
·
Muscle weakness around joints (less support),
repetitive stress (occupational, sports) contribute.
·
Secondary causes: inflammatory arthritis
history, metabolic disorders, avascular necrosis, previous infection, etc.
Signs & Symptoms (Clinical Presentation)
·
Joint pain especially on movement,
weight-bearing, or after prolonged activity.
·
Stiffness of joint, particularly after
inactivity or in the morning (usually less than 30 minutes) or after resting.
·
Reduced range of motion (joint cannot move
fully), difficulty in performing normal movement.
·
Feeling of joint instability or that the joint
is not as strong as usual.
·
Crepitus / grating sensation or audible sound
when joint moves (especially knees).
·
Swelling or enlarged bony prominences around the
joint, tenderness on light pressure.
·
Joint deformity in advanced stages (e.g., bow
legs, genu varum/valgum changes), muscle wasting around the joint.
·
Symptoms increase with load/activity; relieve
with rest.
Diagnostic Tests
·
Clinical examination: history of symptoms +
physical exam (joint tenderness, range of motion, crepitus).
·
Imaging: Plain X-ray of the affected joint(s)
showing joint space narrowing, osteophytes (bone spurs), sub-chondral
sclerosis, cysts, deformity.
·
Occasionally MRI may be used to assess early
cartilage changes or when diagnosis unclear (though not routine).
·
Laboratory tests: though OA is non-inflammatory
type (so minimal elevation of markers), labs may be used to rule out other
types of arthritis (e.g., rheumatoid).
·
Assessment of functional status (mobility, pain
scales) and perhaps BMI, muscle strength around joint for planning management.
c. Management of a Patient with Osteoarthritis [6 marks]
Management of OA is aimed at reducing pain and stiffness,
improving/maintaining joint mobility and function, slowing disease progression,
and enhancing quality of life. Nursing care plays an important role.
Key points of management
·
Non-pharmacologic/ lifestyle interventions:
weight reduction (if overweight) to reduce joint load, regular low-impact
exercise (e.g., swimming, cycling), strengthening peri-joint muscles, joint
protection (avoid excessive load), assistive devices as needed.
·
Physical therapy: range-of-motion exercises,
strengthening, stretching, gait training, use of heat/cold therapy for pain
relief.
·
Pharmacologic treatment: analgesics
(acetaminophen), non-steroidal anti-inflammatory drugs (NSAIDs), topical
agents, intra-articular corticosteroid injections in selected cases.
·
Surgical interventions (in advanced cases):
osteotomy, joint replacement (arthroplasty) when conservative treatment fails
and joint function is severely impaired.
Nursing Management – the role of the nurse:
·
Assessment: pain level, joint stiffness,
functional limitations, gait, muscle strength, mobility, impact on daily
living.
·
Interventions:
o
Provide pain relief measures: apply heat/cold
packs as appropriate; encourage use of analgesics as prescribed; positioning to
reduce joint stress.
o
Promote mobility and exercise: assist patient
with supervised exercise program (as per physiotherapist) to maintain and
improve joint range and strength; encourage walking aids/devices if needed;
plan activities to reduce stiffness (morning exercises).
o
Weight management: monitor weight, counsel
patient about diet and exercise to achieve/maintain optimum weight.
o
Joint protection and safety: educate patient on
avoiding excessive load on affected joints, use of appropriate footwear,
assistive devices (canes, walkers), pacing of activities, rest-activity
balance.
o
Education: teach patient about disease process
(OA is chronic and progressive), importance of adherence to exercise,
medication, joint care; instruct on home modifications (grips, chairs, stairs)
to reduce strain.
o
Support for daily living: assist patient to
modify activities of daily living (ADLs) to reduce pain and joint stress;
encourage independence as feasible; refer to physiotherapy/occupational therapy
if needed.
o
Monitor for complications: although OA is less
inflammatory, ensure patient’s mobility is preserved, monitor for falls risk,
muscle atrophy, joint deformity; report any sudden worsening (could indicate a
different pathology).
·
Evaluation: assess whether patient’s pain is
reduced, joint mobility maintained/improved, functional ability improved,
patient demonstrating correct exercise and joint-care behaviours, weight
reduction progress if applicable.
OR
a. Define Lung Abscess. [3 marks]
A lung abscess is a localized collection of pus and necrotic lung tissue
within the lung parenchyma, forming a cavity (often with an air–fluid level) as
a result of infection and tissue destruction.
b. Aetiology, Clinical Manifestations and Diagnostic Tests for Lung
Abscess [6 marks]
Aetiology (Causes / Risk factors)
·
The most common cause is aspiration of
oropharyngeal secretions (especially in persons with impaired consciousness,
poor oral hygiene, alcohol use, sedation, seizures) leading to anaerobic bacterial
infection of lung tissue.
·
Endobronchial obstruction (tumour, foreign
body), bronchial obstruction causing distal infection/necrosis.
·
Hematogenous spread of infection (less common)
from other infected sites of the body.
·
Pre-existing lung diseases (bronchiectasis,
pneumonia) which predispose to abscess formation via necrosis.
·
Immunocompromised states, periodontal disease,
alcohol abuse, poor swallowing reflex.
Clinical Manifestations (Signs & Symptoms)
·
Fever, chills, night sweats (systemic infection
signs).
·
Persistent cough, initially maybe dry then
productive – sputum may be foul-smelling, putrid, purulent, sometimes
blood-streaked.
·
Chest pain (particularly pleuritic – worse with
deep breathing or coughing).
·
Shortness of breath, fatigue, weight loss, loss
of appetite.
·
On examination: diminished breath sounds,
crackles, possibly signs of consolidation or cavitation on lung fields;
dullness on percussion over abscess area.
Diagnostic Tests
·
Chest X-ray: shows cavity with air–fluid level
(classic) or lung consolidation with cavitation.
·
Chest CT scan: more sensitive to delineate
abscess size, location, differentiate from empyema or tumour.
·
Sputum culture (including anaerobic cultures)
and possibly blood cultures to identify microbial cause.
·
Bronchoscopy may be used in selected cases to
obtain sample, remove obstruction, or foreign body.
·
Laboratory tests: complete blood count (elevated
WBC), inflammatory markers, blood gases if respiratory compromise.
c. Nursing Care Plan for a Patient Admitted in Pulmonary Care Unit
(PCU) with Lung Abscess [6 marks]
Nursing Diagnosis (examples)
·
Ineffective airway clearance related to
increased sputum and exudate within lung cavity.
·
Impaired gas exchange related to destruction of
lung parenchyma and reduced alveolar function.
·
Risk for infection spread (or sepsis) related to
lung cavity containing necrotic tissue.
·
Activity intolerance related to fatigue,
infection and respiratory compromise.
·
Knowledge deficit regarding disease process,
treatment regimen and preventive measures.
Goals / Outcomes
·
Maintain patent airway; expectoration of
secretions, reduction in sputum viscosity.
·
Maintain adequate gas exchange: SpO₂ ≥ target,
PaO₂ within acceptable range, patient free of signs of hypoxia.
·
Control infection; temperature normalises, WBC
count normalising.
·
Patient able to perform ADLs as tolerated with
minimal fatigue.
·
Patient and family demonstrate understanding of
disease, treatment and preventive measures.
Nursing Interventions & Rationales
1. Airway
& breathing support
o
Position patient (semi-Fowler’s) to aid lung
expansion, drainage of secretions.
o
Encourage deep breathing, use of incentive
spirometer, coughing and chest-physio to mobilise secretions.
o
Monitor respiratory rate, rhythm, quality, SpO₂,
auscultation of lungs.
o
Administer humidified oxygen as ordered to
support oxygenation.
2. Monitor
and promote secretion clearance
o
Encourage frequent expectoration of sputum,
instruct the patient on how to cough effectively.
o
Suctioning if required (especially if patient
weak, unable to cough).
o
Maintain hydration (as permitted) to thin
secretions.
3. Infection
control & medication administration
o
Administer antibiotics as prescribed (often
prolonged course for lung abscess).
o
Monitor for side-effects of antibiotics.
o
Monitor vital signs (especially temperature),
complete blood count, infection markers.
o
Maintain sterile technique and infection
prevention measures (hand hygiene, isolation if needed).
4. Support
nutrition & fluid balance
o
Assess nutritional status; encourage
calorie-rich diet (infection increases metabolic demand).
o
Encourage fluid intake to help liquify
secretions unless contraindicated.
5. Activity
& rest balance
o
Pace activity and rest; begin with light
mobilization as tolerated to prevent deconditioning.
o
Monitor for signs of fatigue or breathlessness;
allow rest periods.
6. Patient
education & psychosocial support
o
Explain the nature of lung abscess, reason for
prolonged treatment and importance of completing antibiotics.
o
Teach about posture, breathing/coughing
techniques, hygienic expectoration, oral hygiene to prevent aspiration.
o
Identify risk factors (e.g., alcohol use,
aspiration risk) and advise on modifications.
o
Provide emotional support (prolonged hospital
stay, fear of complications).
7. Monitoring
for complications
o
Observe for signs of empyema, bronchopleural
fistula, hemorrhage, respiratory failure.
o
Monitor labs, imaging follow-up (chest X-ray/CT)
to track resolution of abscess.
Evaluation
·
Patient’s airway remains clear, secretions are
being expectorated effectively, SpO₂ maintained, no signs of hypoxia.
·
Infection under control (normalising
temperature, WBC), chest imaging shows reduction in cavity size.
·
Patient tolerating activity with minimal
fatigue; understands treatment regimen and preventive measures.
·
No new complications observed; patient
progressing towards discharge plan.
III. Write short notes on any three of the following.
Answer:
i. Haemodialysis
Definition
Hemodialysis is a renal replacement therapy that filters waste products and
excess fluid from the blood when the kidneys fail to do so.
Key
Points
- It is used in patients with
end-stage renal disease or severe renal failure where kidneys cannot
maintain electrolyte, acid-base, fluid and waste removal functions.
- The process typically
involves drawing blood from the patient via an access (fistula, graft,
catheter), running it through a dialyser (artificial kidney) where
filtration and diffusion occur, and returning cleansed blood.
- Nurses’ role includes
pre-dialysis assessment (weight, vital signs, fluid status), monitoring
during dialysis for complications (hypotension, cramps, bleeding, access
site infection), and post-dialysis care (monitoring for fluid shifts,
assessing access site).
Important
Considerations
- Monitor fluid removal: weigh
patient before and after to assess fluid removed.
- Protect the vascular access:
no blood pressure measurement or venepuncture on access arm; check for
thrill/bruit.
- Watch for complications:
hypotension, muscle cramps, bleeding, infection, dialysis disequilibrium.
- Patient education:
dietary/fluid restrictions, signs of access infection or malfunction,
adherence to sessions.
ii. Diabetic Ketoacidosis (DKA)
Definition
Diabetic ketoacidosis ed by hyperglycaemia, ketosis and metabolic acidosis due
to severe insulin deficiency.
Key
Points
- Cause: Inadequate insulin →
glucose cannot enter cells → body breaks down fat → ketone production →
acidotic blood.
- Clinical features: polyuria,
polydipsia, dehydration, Kussmaul’s respiration (deep rapid breathing),
fruity breath, nausea/vomiting, abdominal pain, altered mental status.
- Triggering factors:
infections, missed insulin doses, new-onset type 1 diabetes,
stress/trauma.
- Nursing/management:
assessment of vitals + consciousness, monitor blood glucose + ketones +
ABG, IV fluids, insulin infusion, electrolyte (especially potassium)
monitoring, treat underlying trigger.
Important
Considerations
- Early recognition is
critical as it can progress rapidly.
- Monitor for cerebral oedema
(especially in children) when correcting hyperglycaemia too quickly.
- Patient education: insulin
adherence, sick-day rules, recognising early warning signs.
iii. Management of COPD
Definition
Chronic obstructive pulmonary disease (COPD) is a common, preventable lung
disease characterised by persistent respiratory symptoms and airflow limitation
that is not fully reversible. It includes chronic bronchitis and emphysema.
Key
Points
- Causes: long history of
smoking (most common), exposure to noxious particles/gases, alpha-1
antitrypsin deficiency.
- Symptoms: dyspnoea
(breathlessness) on exertion, chronic cough, sputum production, frequent
exacerbations.
- Management
(nursing/medical):
- Smoking cessation (single
most effective measure).
- Pharmacologic:
bronchodilators (inhalers/MDIs), inhaled steroids, combination therapy.
- Oxygen therapy if
hypoxaemic.
- Pulmonary rehabilitation:
exercise training, breathing exercises (e.g., pursed-lip breathing).
- Vaccinations: influenza,
pneumococcal.
- Nursing interventions:
monitor respiratory status (rate, effort, use of accessory muscles),
encourage secretion clearance (humidification, chest physiotherapy),
educate on inhaler technique, nutrition support, preventing
exacerbations.
Important
Considerations
- Prevent exacerbations as
they accelerate disease progression.
- Monitor for complications:
cor-pulmonale (right-sided heart failure), respiratory failure.
- Ensure patients understand
inhaler use, avoid triggers, maintain activity-rest balance.
iv. Common Geriatric Problems
Definition/Overview
Geriatric problems refer to health issues particularly common in older adults
due to age-related physiological changes, comorbidities, polypharmacy and
functional decline.
Key
Points
- Common “giants” of
geriatrics include: immobility, instability (falls), incontinence, intellectual
impairment (dementia).
- Other frequent issues:
vision/hearing impairment, osteoporosis, arthritis, urinary incontinence,
malnutrition, polypharmacy, depression, sleep disorders.
- Nursing considerations:
- Comprehensive
geriatric assessment: functional status, mobility, cognition, nutrition,
social support.
- Fall prevention:
environmental safety, assistive devices, exercise for strength and
balance.
- Incontinence management:
bladder training, scheduled toileting, skin care.
- Polypharmacy review:
monitor drug-interactions, side-effects, simplify regimens.
- Nutritional support: monitor
weight, appetite, dietary needs, address malnutrition risk.
- Sensory deficits: screen
for hearing/vision, refer, adapt environment.
- Social/psychological
support: prevent isolation, depression, cognitive decline.
Important
Considerations
- Focus on maintaining
independence and quality of life, not just disease treatment.
- Early detection of geriatric
syndromes can prevent hospitalisations and functional decline.
- Patient education and family
involvement is key.
v. Peptic Ulcer
Definition
Peptic ulcer disease (PUD) refers to open sores (ulcers) in the lining of the
stomach (gastric ulcer) or in the first part of the small intestine (duodenal
ulcer) caused by erosion from stomach acid/pepsin.
Key
Points
- Causes: infection with
Helicobacter pylori, long-term use of non-steroidal anti-inflammatory
drugs (NSAIDs) are the two most common causes. Symptoms: burning/gnawing
epigastric pain (often relieved by eating in duodenal ulcer), bloating,
heartburn, nausea, sometimes bleeding (haematemesis or melaena).
- Diagnostic tests: endoscopy
(direct visualisation), H. pylori tests (breath test, stool antigen),
barium swallow (less common), blood tests for anemia if bleeding.
- Management:
- Medical: proton-pump
inhibitors (PPIs), H2 blockers, H. pylori eradication therapy
(antibiotics + PPI).
- Lifestyle: stop NSAIDs,
avoid smoking/alcohol, modify diet.
- Nursing care: monitor for
signs of bleeding (drop in BP, tachycardia, black stools), educate about
medication adherence, diet (small frequent meals, avoid irritating
foods), reduce stress.
- Complications to watch:
perforation (sudden severe pain, peritonitis), bleeding, gastric outlet
obstruction.
Important
Considerations
- Patient education is
crucial: complete H. pylori therapy, avoid NSAIDs without doctor’s advice.
- Monitor for complications
and ensure timely referral if perforation or heavy bleeding suspected.
- Nutrition and lifestyle
modifications support healing and prevent recurrence.
IV. A. Write the full forms of the following abbreviations
Sl. No. |
Abbreviation |
Full Form |
i. |
AEP |
Acute
Eosinophilic Pneumonia |
ii. |
CML |
Chronic
Myeloid Leukemia |
iii. |
EBV |
Epstein–Barr
Virus |
iv. |
MRI |
Magnetic
Resonance Imaging |
v. |
CGN |
Chronic
Glomerulonephritis |
vi. |
UPJ |
Ureteropelvic
Junction |
vii. |
ESWL |
Extracorporeal
Shock Wave Lithotripsy |
viii. |
CMV |
Cytomegalovirus |
ix. |
PME |
Post-Mortem
Examination |
x. |
ARF |
Acute
Renal Failure |
B. Fill in the blanks.
Answers :
- Wart (Verruca)
- Cytology / Pap smear
- Premenstrual Syndrome (PMS)
- Salpingectomy
- Methotrexate
- Candida albicans
- Drug-induced dermatitis
- Tonometry
- Air hunger
- Sprain
V. A. Write True/False.
Answers :
i. Hyperglycaemia
is a symptom of Diabetes mellitus. — ✅ True
ii. Ethambutol is a drug used in the treatment of kidney failure. — ❌ False
(It is used to treat tuberculosis)
iii. Warfarin is a blood thinner. — ✅ True
iv. Hashimoto's disease is an autoimmune disorder causing thyroiditis. —
✅ True
v. Normal bleeding time is 5–10 mins. — ❌ False (Normal bleeding
time is 2–7 minutes)
vi. Spinal anaesthesia is administered between T3–T4 space. — ❌ False
(It is given in the L3–L4 or L4–L5 space)
vii. Myocardial infarction is called heart attack. — ✅ True
viii. Palpation is done by the stethoscope. — ❌ False
(Palpation is done by hand, Auscultation is done by stethoscope)
ix. Poliomyelitis is a viral infection. — ✅ True
x. Haemophilia is a hereditary disease. — ✅ True