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)

Duration: 3 Hours 
Max.Marks:75

Answer all questions.
Figures in the right-hand margin indicate marks

I.     Solve answer question 

a. What is renal failure.
[3]
b. Write briefly to explain aetiology, clinical presentation and complications of chronic renal failure.
[5]
C. Describe the nursing management of a patient with chronic renal failure
[7]

OR

a. Define Shock.
[3]
b. Enlist the types of Shock, its clinical manifestations and complications.
[6]
C. Write the nursing management of a patient with shock according to priority basis.
[6]

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.

 OR

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:

  1. Hypovolemic shock – due to loss of blood or fluid volume (e.g., severe bleeding, dehydration, burns)
  2. Cardiogenic shock – pump failure of the heart (e.g., myocardial infarction, severe heart failure)
  3. Obstructive shock – physical obstruction of blood flow (e.g., tension pneumothorax, cardiac tamponade, pulmonary embolism)
  4. 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

  1. 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).
  2. 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.
  3. 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.
  4. 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).
  5. 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.
  6. 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 

a. What is Osteoarthritis?
[2]
b. Write the causes, signs, symptoms and diagnostic tests for detection of osteoarthritis.
[7]
C. Write in brief about the management of a patient with osteoarthritis.
[6]

OR

a. Define lung abscess.
[3]
b. Describe the aetiology, clinical manifestations and diagnostic tests for detecting lung abscess.
[6]
c. Prepare a nursing care plan for the patients admitted in pulmonary care unit of the hospital.
[6]

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.

[3 x 5= 15]
i. Haemodialysis
ii. Diabetic ketoacidosis
iii. Management of COPD
iv. Common geriatric problems
v. Peptic ulcer

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

[ 1 x 10 = 10]
i. AEP
ii. CML
iii. EBV
iv. MRI
v. CGN
vi. UPJ
vii. ESWL
viii. CMV
ix. PME
X. ARF

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.

[1 x 10 = 10]
i. A painful papillomatous growth caused by a virus that may occur on any part of the skin or sole is known as ______.
ii. Microscopic study of exfoliated cells via special staining and fixation technique to detect abnormal cells is called ________.
iii. A cluster of distressing physical and behavioural symptoms that occur at the second half of the menstrual cycle followed by a symptom free period is called ________.
iv. The surgery for removal of fallopian tube is called _______.
v. Anti-cancer drug causing photosensitivity is called _______.
vi. Candidiasis is caused by _______.
vii. Dermatitis medicamentosa is called _______.
viii. ______ is a measure of intra ocular pressure.
ix. Kussmaul's respiration is also known as ______.
x. An injury to the ligament around a joint usually caused by twisting motion is called _______.

Answers :

  1. Wart (Verruca)
  2. Cytology / Pap smear
  3. Premenstrual Syndrome (PMS)
  4. Salpingectomy
  5. Methotrexate
  6. Candida albicans
  7. Drug-induced dermatitis
  8. Tonometry
  9. Air hunger
  10. Sprain


V.  A. Write True/False.

[1 x 1 = 10 ]
i. Hyperglycaemia is a symptom of Diabetes mellitus.
ii. Ethambutol is a drug used in the treatment of kidney failure.
111. Warfarin is a blood thinner.
IV. Hashimoto's disease is an autoimmune disorder causing thyroiditis.
V. Normal bleeding time is 5-10 mins.
vi. Spinal anaesthesia is administered between T3-T4 space.
vii. Myocardial infarction is called heart attack.
viii. Palpation is done by the stethoscope.
ix. Polio myelitis is a viral infection.
X. Haemophilia is a hereditary disease.

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


 





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