2nd Year GNM Nursing ODISHA Medical and Surgical Nursing II 2025

ODISHA NURSES & MIDWIVES EXAMINATION BOARD

SECOND YEAR ANNUAL EXAMINATION IN GNM-2025

Paper-II

(Medical and Surgical Nursing II)

Duration: 3 Hours

Max.Marks:75

Answer all questions.

Figures in the right-hand margin indicate marks

I. Solve answer question

a. What is angina pectoris.

[3]

b. Write briefly to explain types and aetiology angina pectoris.

[5]

c. Describe the nursing management of a patient with angina pectoris

[7]

OR

a. Define Glaucoma

[3]

b. Enlist the types of Glaucoma, cause, clinical manifestations and its complications.

[6]

c. Write the medical and nursing management of a patient with Glaucoma.

[6]

a. What is angina pectoris? [3]

Angina pectoris is chest pain or discomfort that occurs when the heart muscle (myocardium) does not receive enough oxygenated blood.
In simpler terms: when there is a temporary imbalance between myocardial oxygen supply and demand, the heart responds with pain or pressure in the chest.

b. Types and aetiology of angina pectoris [5]

Types of angina pectoris
Here are common types:

Stable angina: predictable chest pain, triggered by exertion or stress, relieved by rest or medication.
Unstable angina: pain is more frequent, occurs at rest or with less exertion, more severe, may not be fully relieved by rest or usual medication.
Variant (Prinzmetal) angina: caused by coronary artery spasm (rather than fixed atherosclerotic plaque) often at rest, sometimes at night.
Microvascular angina: angina symptoms but with small-vessel coronary disease rather than large coronary arteries.

Aetiology / causes (why it happens)

Atherosclerosis of the coronary arteries → plaque formation narrowing the lumen → reduced blood flow to myocardium during increased demand.
Coronary artery spasm (in variant angina) causing transient narrowing of the vessel.
Increased myocardial oxygen demand: from exercise, emotional stress, cold exposure, heavy meals, tachycardia, hypertension.
Reduced supply due to coronary thrombosis (especially in unstable angina) or severe narrowing.

Putting it all together: The imbalance between supply (reduced) and demand (increased) of oxygen to the heart muscle leads to ischemia, which causes the chest pain characteristic of angina.

c. Nursing management of a patient with angina pectoris [7]

Here is a structured nursing management approach (assessment → planning → interventions → evaluation) tailored for a patient with angina:

Assessment / Nursing Diagnosis

Assess onset, duration, location, nature (squeezing, pressure, heaviness) of chest pain; radiation (jaw, arm, back), factors that precipitate or relieve it.
Monitor vital signs: heart rate, blood pressure, respiratory rate, SpO₂ (oxygen saturation).
Monitor ECG changes (ST depression, T-wave inversion) if available & ordered.
Assess risk factors: hypertension, diabetes, hyperlipidaemia, smoking, family history, obesity, sedentary lifestyle.
Evaluate for complications: progression to myocardial infarction, arrhythmias.

Planning / Goals

Patient will have relief of angina pain or reduction in frequency/severity of episodes.
Patient will maintain effective myocardial perfusion and prevent further ischemic injury.
Patient will understand and adhere to therapeutic regimen and lifestyle modifications.
Patient will recognise angina triggers and know when to seek help.

Interventions

During acute angina episode:

Place patient in comfortable position, preferably semi-Fowler’s or upright to reduce cardiac workload.
Administer oxygen if SpO₂ < 90% or if signs of respiratory distress.
Administer anti-anginal medications as prescribed (e.g., sublingual nitroglycerin, nitrates, beta-blockers, calcium channel blockers, antiplatelet therapy).
Monitor for and manage complications: dysrhythmias, hemodynamic instability, transition to MI.

Ongoing nursing care:

Monitor vital signs regularly and observe for changes in pain pattern or new symptoms.
Educate patient on recognizing early symptoms (chest discomfort, radiation, associated symptoms like diaphoresis, nausea) and when to call for help.
Teach lifestyle modifications: smoking cessation, weight management, regular moderate physical activity, diet low in saturated fats, control of hypertension & diabetes, avoiding heavy meals/cold exposure/emotional stress as triggers.
Encourage adherence to medications, understanding of how & when to use (for example, nitroglycerin under tongue at onset of pain, when to call ambulance).
Provide emotional support and reassure patient to reduce anxiety (which can increase cardiac workload).
Coordinate care with the multidisciplinary team: ECG, lab tests (troponin, lipid profile), cardiologist referrals, possibly angiography or intervention if indicated.

Evaluation

Check if chest pain episodes have reduced in frequency/intensity.
Check if the patient performs the daily activities with fewer symptoms or none.
Evaluate if the patient reports trigger recognition and uses prescribed medication correctly.
Evaluate if cardiovascular risk factors are being managed (BP, cholesterol, blood sugar, lifestyle).
Monitor for absence of complications like myocardial infarction, heart failure, arrhythmias.

a. Define Glaucoma [3]

Glaucoma is a group of eye disorders characterised by damage to the optic nerve (and retinal ganglion cells/axons), frequently associated with elevated intra-ocular pressure (IOP), which can lead to progressive vision loss and blindness.

b. Enlist the types of Glaucoma, causes, clinical manifestations and its complications [6]

Types of Glaucoma
Some major types include:

Primary open-angle glaucoma (POAG) – the most common form; drainage angle is open but outflow is reduced.
Angle-closure (or closed-angle) glaucoma – drainage angle is blocked/narrowed so fluid can’t escape easily; can be acute.
Normal-tension (or low-tension) glaucoma – optic nerve damage occurs despite IOP not being significantly elevated.
Congenital glaucoma – present in infancy due to abnormal development of drainage structures.
Secondary glaucoma – due to other eye disease, trauma, surgery, steroids, etc.

Causes / Aetiology

Raised intra-ocular pressure (IOP) because of impaired drainage of aqueous humour (or rarely increased production).
Structural abnormalities of the drainage angle (especially in congenital or angle-closure types).
Eye trauma or inflammation causing damage/blockage to drainage structures (in secondary glaucoma).
Risk factors: age over ~40–60, family history, high eye pressure, certain medications (steroids), myopia/hyperopia, diabetes/hypertension.

Clinical Manifestations

In open-angle glaucoma: often initially asymptomatic (no pain) until vision loss is significant; gradual peripheral (side) vision loss, then central vision.
In acute angle-closure glaucoma: sudden eye pain, headache, nausea/vomiting, blurred vision, seeing halos around lights, redness of eye.
Other signs: raised IOP on tonometry, optic disc cupping on ophthalmoscopy, visual field defects.

Complications

Progressive vision loss and eventual blindness if untreated.
Optic nerve damage (irreversible).
For angle-closure: acute crisis leading to very high IOP, corneal edema, permanent vision loss.

c. Medical and nursing management of a patient with Glaucoma [6]

Medical management

The main goal: reduce intra-ocular pressure (IOP) to slow or halt damage to the optic nerve.
Treatments include: topical eye-drops (e.g., prostaglandin analogues, beta-blockers, carbonic anhydrase inhibitors, α-agonists), oral medications, laser therapy (e.g., laser trabeculoplasty), surgical interventions (e.g., trabeculectomy).
For acute angle-closure: immediate reduction of IOP, may require emergency interventions.
Regular monitoring, review of optic nerve status, visual fields, IOP.

Nursing management

Assess baseline: visual acuity, visual fields, IOP (if equipment/doctor), optic disc appearance, patient history including risk factors.
Monitor for symptoms: eye pain, halos, changes in vision, headache (especially in acute angle-closure).
Administer medications as ordered: ensure correct eye-drop technique, timing, dosage, warn about systemic side-effects.
Educate patient: about the chronic nature of glaucoma, emphasise that vision loss once occurred is usually irreversible, so adherence to therapy is critical.
Teach proper eye drop administration: e.g., avoid touching bottle tip, tilt head back, drop into conjunctival sac, close eye for a minute, avoid blinking vigorously, wash hands.
Encourage regular follow-up ophthalmic exams (visual fields, IOP checks).
Monitor for and report side-effects of medications (e.g., bradycardia with ocular beta-blockers, local irritation).
Educate lifestyle and risk-factor modification: control diabetes/hypertension, avoid excessive steroid use, encourage protective eyewear if trauma risk.
For acute angle-closure: ensure patient recognises emergency signs (sudden pain, blurred vision, halos) and seeks immediate care.
Provide psychological support: fear of vision loss, reassure about management, involve family, encourage support systems.

II. Solve Answer Questions

a. Define fracture

[2]

b. Write the types of fracture and enumerate it's clinical manifestations.

[7]

c. Briefly in detail about the emergency management of a patient with fracture.

[6]

OR

a. Define Dermatitis.

[3]

b. Describe the aetiology, clinical manifestations and various typesof dermatitis.

[5]

c. Prepare a nursing care plan for the patients suffering from dermatitis.

[7]

a. Define fracture [2]

A fracture is a break, crack or disruption in the continuity of a bone.
In other words: when bone tissue is subjected to a force greater than it can withstand, leading to partial or complete separation of bone segments.

b. Types of fracture and enumerate its clinical manifestations [7]

Types of fractures (selection of the common ones):

Closed (or simple) fracture – bone is broken but skin remains intact.
Open (or compound) fracture – broken bone with overlying skin laceration or bone protruding.
Complete fracture – bone breaks all the way through its cross-section.
Incomplete fracture – bone is cracked or broken partially (not through entire cross-section).
Comminuted fracture – bone is broken into several fragments.
Impacted fracture – one fragment is driven into another (compression type).
Oblique, transverse, spiral, greenstick etc – e.g., fractures at angles, twist, in children only one side (greenstick).

Clinical manifestations:

Pain and tenderness at the site of the fracture.
Swelling and/or oedema around the injured area.
Inability or difficulty to move the affected limb or use the part as usual.
Bruising or haematoma formation (discolouration) around the site.
Visible deformity, abnormal angulation or mis‐alignment of the bone ends.
Warmth, redness, or increased local temperature due to inflammation.
Crepitus (grating sound) if bone ends rub each other (less in exam answers but good to mention).

c. Briefly in detail about the emergency management of a patient with fracture [6]

Emergency (initial) management steps for a fractured patient:

Ensure safety & assess general condition: Check airway, breathing, circulation (ABCs) if major trauma. Stabilize patient.
Assess the injured part: inspect for deformity, open wound (if any), bleeding, vascular status (pulses, capillary refill), neurological status (sensation, movement).
Immobilise the fracture site: Without causing further injury, align gently if gross deformity, apply splint or support to prevent movement of fractured ends.
Control bleeding & cover open wounds: If open fracture, cover wound with sterile dressing, avoid contamination. Consider risk of infection.
Pain management: Administer analgesics as prescribed, apply ice pack or cold compress (if no contraindication), elevate limb if possible.
Monitor for complications: such as shock, fat embolism (especially with long bone fractures), compartment syndrome, neurovascular compromise. Keep frequent checks of the 6 P’s: Pain, Pulse, Pallor, Paresthesia, Paralysis, Poikilothermia (temperature difference).
Then transport the patient for definitive treatment (e.g., X-ray, reduction, fixation) once stabilized.
If needed, maintain the patient in a position of comfort, keep the injured limb immobilised during transfer, ensure analgesia and monitoring en-route.

a. Define Dermatitis [3]

Dermatitis is a general term for inflammation of the skin. The word derives from “derm” = skin and “itis” = inflammation.
It is characterised by redness, swelling, itchiness, rash, dry or scaly skin and may also involve oozing or crusting.

b. Describe the aetiology, clinical manifestations and various types of dermatitis [5]

Aetiology (causes) of dermatitis:

Genetic predisposition (especially in atopic dermatitis) with skin barrier dysfunction and immune hyper-reactivity.
Contact with irritants (soaps, detergents, chemicals, rough fabrics) leading to irritant contact dermatitis.
Contact with allergens (nickel, cosmetics, preservatives, plants) causing allergic contact dermatitis.
Environmental factors: extremes of temperature, humidity changes, stress, infection, systemic disease may trigger or aggravate.
Other types: secondary to systemic disease or medications (e.g., exfoliative dermatitis).

Clinical manifestations:

Redness (erythema) and swelling of skin.
Itching (pruritus) which may be intense.
Dry, scaly skin, or crusting, vesicles or oozing in acute phases.
Lesions depend on type: e.g., in contact dermatitis acute phase: vesicles, pustules; chronic phase: thickened, leathery skin (lichenification) from scratching.
Distribution often corresponds to contact area (in contact dermatitis).

Various types of dermatitis:

Atopic dermatitis (eczema)
Contact dermatitis: irritant and allergic types
Seborrheic dermatitis
Diaper dermatitis, dyshidrotic dermatitis, nummular dermatitis, stasis dermatitis etc.

c. Prepare a nursing care plan for the patients suffering from dermatitis [7]

Below is a sample nursing care plan format for a patient with dermatitis (you may assume atopic/contact or general type). You can adapt for a specific type if required.

Nursing Care Plan

Nursing Diagnosis	Desired Outcomes	Nursing Interventions	Rationales
1. Impaired skin integrity related to rash, inflammation and scratching.	Skin will remain intact or show signs of healing (reduced redness/crusting) within x days; patient reports decreased itching.	• Assess and document skin lesions: location, size, colour, presence of vesicles/crusts, oozing. • Encourage gentle cleansing with mild soap and warm water, pat dry; apply moisturiser. • Apply topical medications (creams/ointments) as prescribed (e.g., corticosteroids, calcineurin inhibitors). • Instruct avoidance of known irritants/allergens (identify triggers during history). • Keep nails trimmed, advise against vigorous scratching. • Maintain appropriate ambient temperature/humidity; avoid excessive heat or cold. • Monitor for signs of secondary infection (pus, increased redness, systemic signs).	Gentle cleansing and moisturising restore skin barrier; topical therapy reduces inflammation; avoiding triggers prevents new lesions; scratch prevention reduces damage; controlling environment reduces flare; infection monitoring prevents complications.
2. Disturbed sleep pattern related to pruritus and discomfort.	Patient will sleep without awakening due to itching more than once per night within x days.	• Encourage evening bath with lukewarm water, apply emollient after bath. • Administer anti‐pruritic medication (as ordered) and soothing measures (cool compress). • Educate patient on relaxation techniques before bedtime (to reduce stress which can flare the dermatitis).	Moisturising before sleep reduces dryness itch; medication and soothing reduce scratching; stress reduction helps control flare.
3. Knowledge deficit (care of dermatitis) related to chronic nature of disease and trigger avoidance.	Patient/caregiver will verbalise at least 3 triggers and proper skin care regimen by discharge.	• Provide teaching: nature of dermatitis, chronicity, importance of ongoing skin care; avoidance of known triggers/allergens. • Demonstrate correct application of topical medication and moisturiser. • Provide written materials (leaflets) about dermatologist referral when needed. • Emphasize follow-up visits, monitoring of flare ups.	Educated patients are more likely to adhere to care, recognise early signs of flare and prevent complications.

Evaluation:

Assess skin condition: decreased redness, fewer lesions, absence of new vesicles/crusting.
Ask patient about itching intensity and frequency of awakenings.
Confirm patient's understanding of trigger avoidance and correct skin care.
Monitor for absence of secondary infection.

III. Write short notes on any three of the following.

[3 x 5= 15]

a. Classification of burn

b. Chemotherapy

c. Cellulitis

d. Eye bank

e. Infection control measures for communicable diseases

a. Classification of burns

Definition: A burn is tissue damage caused by intense heat, chemicals, electricity, radiation, or friction.
Classification:

By depth (degree)

First-degree (superficial): only epidermis involved; red, painful, no blisters.
Second-degree (partial-thickness): epidermis + part of dermis; red, blistered, painful.
Third-degree (full-thickness): epidermis + dermis destroyed, may involve subcutaneous tissue; skin may appear black, white or leathery; nerve endings destroyed (may reduce pain).
Fourth-degree: extends into muscle, bone, or underlying structures beyond skin.

By mechanism / aetiology

Thermal burns (hot liquids, flames)
Chemical burns (acids, alkalis)
Electrical burns (current through body)
Radiation burns (sunlight, X-rays)

By extent / size (e.g., total body surface area, TBSA) — although this is more of severity rather than classification, it is relevant for management.
Key point for exam: When you write classification, mention at least ‘depth (1st/2nd/3rd/4th degree)’ and optionally mechanism/type.

b. Chemotherapy

Definition: Chemotherapy refers to the use of chemical (drug) agents to kill or inhibit the growth of disease cells — most commonly cancer cells.
Key aspects:

Function: These drugs target rapidly dividing cells (such as malignant cancer cells) to stop growth, spread, or recurrence of cancer.
Modes of use: Can be used alone or combined with surgery, radiation, immunotherapy etc.
Nursing implications: Because chemo affects healthy rapidly dividing cells too (e.g., bone marrow, GI tract, hair follicles) it has significant side-effects (e.g., nausea, hair loss, immune suppression) and requires careful administration and monitoring.
Safety & administration: Nurses must ensure correct drug, correct patient, correct dose, correct route and monitor for extravasation (if IV), side-effects, and provide patient education.
Short note to remember: “Use of anti-cancer drugs to destroy/inhibit malignant cells, often systemic; major nursing role in administration, monitoring, side-effect management and patient education.”

c. Cellulitis

Definition: Cellulitis is a common, potentially serious bacterial infection of the skin and the subcutaneous tissues (non‐necrotising inflammation of deeper skin layers) usually characterised by spreading redness, swelling, warmth and pain at the affected site.
Key features:

Typical causes: breach in skin integrity (wound, insect bite, etc) allowing bacteria (often Staphylococcus aureus or Streptococci) to enter.
Clinical manifestations: redness, swelling, warmth, pain/tenderness, often indistinct margins, possible chills/fever.
Treatment/management: antibiotics (oral or IV depending on severity).
Short note: Focus on “what it is”, “common cause”, “features” and “brief how managed”.

d. Eye bank

Definition: An eye bank is a facility or organisation that recovers, processes, preserves, evaluates and distributes donated ocular tissue (especially corneas) for transplantation, research and education.
Key points:

Role: Encourage eye/cornea donation, retrieve the tissue after death (with consent), medically evaluate donor tissue, store/preserve it, distribute to surgeons for corneal transplants.
Importance: Corneal blindness is a major cause of vision loss globally; eye banks help restore sight through transplantation.
Nursing relevance: Nurses may be involved in donor counselling, caring for donors (in hospital setting post mortem), maintaining tissue integrity, ethical aspects of consent and eye-donation awareness.
Short note: “Organisation for corneal/ocular tissue donation & supply for sight restoration, with functions of retrieval, evaluation, preservation, distribution.”

e. Infection control measures for communicable diseases

Definition/overview: Infection prevention and control (IPC) refers to evidence-based practices that prevent the spread of communicable (infectious) diseases among patients, health-care workers and the community.
Key measures (short form summary):

Hand hygiene: frequent, correct hand-washing or use of alcohol-based hand rub.
Use of Personal Protective Equipment (PPE): gloves, masks, gowns, eye protection as appropriate.
Standard precautions: applied to all patients regardless of diagnosis (e.g., safe injection practices, disposal of sharps, respiratory hygiene).
Transmission-based (additional) precautions: for known or suspected communicable diseases — e.g., contact, droplet, airborne precautions (isolation, special ventilation, dedicated equipment).
Environmental cleaning and disinfection: regular cleaning of surfaces, disinfection of equipment, safe laundry, waste management.
Surveillance, early identification, isolation/quarantine of infectious cases, vaccination (where applicable) and education of staff & public.
Short note: Mention the “bundle” of measures (hand hygiene, PPE, standard + transmission-based precautions, cleaning/disinfection, isolation), emphasise their role in preventing spread of communicable diseases.

IV. A. Write the responsibilities and role of a nurse in the following situations.

[2 x 5 = 10]

a. Educating a patient on self-care for pharyngitis.

b. A patient with an insect in the ear.

c. A patient with fracture hand.

d. A patient with conjunctivitis.

e. A patient with food poisoning.

a. Educating a patient on self-care for Pharyngitis